Ingrown Toenail

What is an ingrown toenail?

An ingrown toenail (also known as onychocryptosis) is when part of the nail grows into surrounding skin. It may cause infection and can be extremely painful.

The most common cause is trimming toenails incorrectly, and the nail most likely to become ingrown is the big toe. Wearing shoes that are too tight or too narrow can also lead to ingrown toenails.

Other causes include injuries, fungal infections, abnormalities in your foot structure, or repeated pressure and pounding of the feet while exercising.

Treatment starts with soaking the toes in warm, soapy warm water. If untreated, an ingrown toenail can cause an infection, which can lead to more serious pain and problems.

Infected ingrown toenail

If an ingrown toenail is not treated or not clean and dry, it may become infected. This means that bacteria or fungus can get into your skin, causing more pain and swelling. The bacteria can grow deeper and create a pocket of infection, called an abscess. Abscesses may need to be surgically drained.

When the toenail becomes infected, it may need to be surgically removed and you may need antibiotic medicine to treat the infection.

Most common symptoms

The most common symptom is pain. This pain is often intense, can affect your ability to walk, and feels much worse than it looks. You may change the way you walk to avoid putting pressure on the affected toe. The pain can get momentarily worse if you accidentally bump your toe.

The skin around the nail can also become red and swollen. Swelling does not necessarily mean the toe is infected, but if you notice worsening redness, pus drainage, swelling, warmth—or you have a fever—it may be infected.

Main symptoms

• Pain feels much worse than it looks
• Swelling on one side of the nail
• Redness
• Distorted color, shape, or thickness of the nail
• Blood-tinged or clear drainage of fluid from the ingrown nail
• Avoiding activities or walking funny to avoid the pain

Other symptoms you may have

If the toenail becomes infected, you may have the following additional symptoms:

• Redness that spreads as time goes on
• Warmth of the affected toe
• Tenderness when you touch the affected toe
• Pus (white or yellow fluid) coming out near the nail
• Fever, chills, and feeling generally sick

Risk factors

Improper nail trimming is the biggest risk factor for getting an ingrown toenail. Cutting the nail too short, into a V-shape, or into a rounded shape are all improper cuts (it should be trimmed straight across). Tearing your nails instead of cutting them with a clipper can also increase your risk.

Other risk factors include:

• Not cleaning your toes regularly
• Keeping your toes in a moist environment instead of letting them dry
• Having a family history of ingrown toenails
• Excessive sweating from your feet
• More common in males, teenagers and young adults (ages 12 to 22), and the elderly

Baby ingrown toenail

Babies can also develop ingrown toenails. Typically, the big toe is affected. To prevent this toenail problem, nails should always be trimmed straight across with none of the nail bed exposed. Make sure your baby’s shoes are not too tight (or loose).

If your toddler develops a funny walk or is crying when any pressure is placed on a toe, check for an ingrown toenail. If the toenail looks infected (red and swollen), take them to the doctor.

Next steps

See a doctor if the nail shows signs of infection (red, swollen, etc.), but you typically do not have to go to an emergency room.

Ingrown toenails that aren’t infected can be treated at home without needing any prescriptions or procedures.

Causes

An ingrown toenail is usually caused by incorrectly trimming your toenails—not cutting it straight across. That causes a tiny spear or barb nail that pushes into the nail bed or grows into the skin. It can cause inflammation and infection because it allows bacteria to get into your skin and nail bed.

Other causes include too tight or too narrow shoes, injuries, fungal infections, abnormalities in your foot structure, or repeated pressure and pounding of the feet from exercising.

Treatment

The most important and easiest treatment is to soak the toenail in warm, soapy water for 10 to 20 minutes, then thoroughly drying your foot. Try to do 2 to 3 times per day until it gets better.

In general, you should soak your toes and apply either an antibiotic or steroid cream:

• Antibiotic ointments: Over-the-counter bacitracin or the prescription mupirocin can be applied after soaking your toe in warm, soapy water.
• Steroid ointments: Over-the-counter hydrocortisone or prescription triamcinolone can be applied after you soak your toe in warm, soapy water.
• Gently placing a piece of a cotton puff or dental floss underneath the edge of the ingrown toenail (after you have cleaned and dried the nail thoroughly) helps lift the nail off the nail bed, allowing it to heal.

Ingrown toenail removal

If the skin around the nail becomes infected, see your doctor. They may prescribe an antibiotic drug or perform a minor procedure in which a small portion of the ingrown nail is cut away.

If this doesn’t help, you may need a minor surgery to remove the nail and drain any bacteria there. Sometimes, your primary care doctor can do this, but most often, you will be sent to a foot doctor (podiatrist) to do the procedure.

For this surgery, you are given an injection of a local anesthetic in the toe. Then, the nail is either partially or fully removed (lifted) off the nail bed. The doctor can also check for an abscess (collection of bacteria) that needs to be drained. With the local anesthetic, you will feel pressure but not any sharp pain.

Follow up

If it is a simple, uncomplicated ingrown toenail and not infected, your doctor may just tell you to soak in soapy water. You probably won’t need to follow up.

If the nail is infected, the doctor may want you to come back to make sure the infection is gone. If you need surgery, you will probably have another appointment after the procedure. You should also follow all special post-surgical instructions for keeping the toe clean and dry.

Preventative tips

• The best way to trim your toenails is to use a toenail clipper, not scissors.
• You should never tear nails.
• Cut nails straight across so that they are slightly longer than the fleshy tips of the toes. In other words, you should not be able to see the nail bed—you should only be able to see the nail.
• Do not cut your nails in a curve or cut them too short.
• Clean your feet regularly and keep them as dry as possible to avoid infection and breakdown of the skin.
• Always buy correctly sized footwear, not too tight or too loose.