Ingrown toenail

​​What is an ingrown toenail?

An ingrown toenail occurs when a side of the nail grows into the surrounding skin instead of straight outward. Since the nail cuts into the skin, it is common for the area to become infected or inflamed.

Ingrown toenails cause a lot of discomfort and can be very painful. They are a common problem, especially in teenagers and young adults.


How does an ingrown toenail affect the body?

An ingrown toenail is most likely to occur on the big toe, but any toe can be affected.

At first, the skin around the ingrowing nail may become red and feel slightly tender. Small openings in the skin can then allow bacteria to enter, which can cause the area to become infected.

If an infection occurs, the skin may become more swollen, red and painful. Some yellow or green pus (fluid) may start oozing from around the nail. The area may also produce a bad smell. Over time, the skin around the nail can overgrow, causing more pain.

If left untreated, an ingrown toenail can lead to cellulitis, a type of skin infection. In extremely rare cases, it can lead to osteomyelitis, an infection of the bone.

What causes an ingrown toenail?

An ingrown toenail can have a number of causes, including:

  • poorly-fitting shoes
  • inadequate trimming of the nails
  • tearing or picking at the nail
  • repeated pressure or impact on the nail
  • unusual feet, toes or nails.
 

Shoes

Shoes that are too narrow or those that put pressure over the nails are more likely to cause ingrown toenails.

Nail trimming

Trimming the nails too much or rounding the edges instead of cutting right across can lead to ingrown toenails.

Picking at nails

Ingrown toenails are more likely in children who pick at their toenails.

Pressure or impact on the nail

An ingrown toenail is more likely to occur following a bump or other injury to the toe. For example, active, sporty people may be more likely to develop ingrown toenails because their feet might be more prone to pressure and injury. The increased sweating that results from physical activity also makes it easier for bacteria to thrive and cause an infection.

Unusual feet, toes or nails

Sometimes deformities of the foot or toes can place extra pressure on the nails. In addition, some people are born with curved nails that grow downward. Others have toenails that are too big for their toes. Some of these conditions may improve on their own over time.

Ingrown toenail: Early treatment with tape

1) Attach one end of a piece of tape to the skin beside the ingrown toenail. 2) Move skin out of the way by gently pulling the tape was you start to wrap it around the toe. 3) Stick the two ends of the tape together at the front of the toe, near the cuticle.

How is an ingrown toenail diagnosed?

A doctor can diagnose an ingrown toenail by examining your child and asking questions about how they feel when they walk.

Inspect your child’s feet often to look for any signs of an ingrown toenail. One early sign is redness and swelling of the skin near the edge of the nail. If the ingrown nail is infected, your child may develop a fluid-filled blister. Your child may also complain that their foot hurts or may limp or wince when they walk.

How is an ingrown toenail treated?

Several options are available to treat an ingrown toenail.

The early signs can be resolved by:

  • wearing wider or open-toed footwear
  • trimming nails properly
  • finding ways to allow the nail to grow out of the skin, for example by using tape to pull the skin beside the nail out of the way.

Other treatments for ingrown toenails include soaking the foot in a mix of lukewarm water and mild soap before applying an antiseptic or topical antibiotic. During the day, while your child is wearing shoes, the toenail would be covered with a bandage. At night, the bandage would be removed to allow the toenail to "air out" in bed.

If an infection develops, your child will need to take antibiotics to treat it and prevent complications. In rare cases, your child might need surgery to resolve the problem.

How to treat repeated episodes of ingrown toenail

If your child experiences ingrown toenail repeatedly, they may need surgery (an operation) to remove part of their nail. This involves a number of steps.

  1. Your child is injected with a local anaesthetic into the base of their toe to numb it.
  2. A surgeon cuts their toenail the long way (towards the cuticle), just a few millimetres from the problem edge.
  3. Ingrown toenail surgery
     
  4. If the nail bed has been exposed a number of times, the surgeon may apply some medication to help stop the edge of the nail from re-growing and causing another ingrown toenail.
  5. The surgeon dresses the nail with a bandage.

The surgeon will tell you how to care for the area around the nail as it heals.

When to see a doctor for ingrown toenail

See your child’s doctor if:

  • you have checked your child and noticed early signs of an ingrown toenail but would like a clear diagnosis
  • your child’s symptoms continue after you have treated the early signs of an ingrown toenail
  • your child complains of pain across the toe
  • your child shows signs of infection beside the nail, such as redness, pus or a bad smell
  • your child has a fever.

Key points

  • An ingrown toenail occurs when the toe grows into the surrounding skin, causing pain and discomfort.
  • The causes of ingrown toenails include tight footwear, poorly trimmed nails and repeated bumps to the toes.
  • The early signs and symptoms of an ingrown toenail include redness and tenderness as well as pain.
  • Early on, an ingrown toenail can be treated by improving footwear, trimming nails straight across and applying an antiseptic cream, if needed.
  • Later signs of ingrown toenail include pus, a bad smell or a fever. If your child has these signs and symptoms, they should see a doctor because they may need antibiotics.
Carmen Liy Wong, MD
Irene Lara-Corrales, MSc, MD
7/7/2016

Further information

For more information about ingrown toenails, visit Foot Health Facts, from the American College of Foot and Ankle Surgeons, or the website of the UK College of Podiatry.​





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