An ingrown toenail happens when the edges or corners of the nail grow into the skin next to the nail and break the skin.

It is a common condition, and it can be painful, causing swelling, redness, and sometimes infection. It usually affects the big toe, the "thumb" of the foot, either on one or both sides of the toe.

Ingrown toenails can usually be treated at home, but if the pain is severe or spreading, it may be necessary to see a health care provider, to prevent complications and relieve symptoms.

People with poor circulation, such as those with diabetes or peripheral vascular disease, are more likely to have complications.

INGROWN TOENAIL

Causes

Here are some of the causes of ingrown toenails:

Footwear: Shoes and socks that crowd the toes and toenails increase the chance of an ingrown toenail. Shoes can be too tight because they are too short, too narrow at the end, or too flat at the end. Tight-fitting socks, tights, or stockings may cause ingrown toenails.

Cutting the toenails too short: Not cutting straight across or cutting the edges of the toenail can encourage the surrounding skin to fold over the nail. The nail can then push into that skin and pierce it.

Toenail injury: Dropping something on the toe, kicking something hard, and other accidents can lead to ingrown toenails.

An unusual curvature: This increases the risk that the toenail will grow into the soft tissue, causing inflammation and possible infection.

Posture: How a person walks or stands can affect the likelihood of developing ingrown toenails.

Poor foot hygiene or excessive sweating: If the skin on the toes and feet is moist and warm, there is a higher chance of developing an ingrown toenail. A fungal infection can increase the risk.

Heredity: ingrown toenails can run in families.

Genetic factors: Some people are born with larger toenails.

Symptoms

At first, the skin next to the nail may be tender, swollen, or hard.

When the nail pierces the skin, bacteria can get in, resulting in infection. The area affected becomes red, swollen, warm, and painful. There may be bleeding and pus.

Anyone with symptoms of infection should seek medical help, either a primary care physician, orthopedic surgeon, or foot care specialist, known as a podiatrist.

Seeing a doctor

The patient should see a doctor if:

  • they have diabetes or a circulatory problem

  • symptoms do not go away

  • an infection develops

A healthcare professional may remove some of the nail that is pushing into the skin.

They may need to remove a portion of the nail and the underlying nail bed to prevent the problem from coming back.

Surgery

If the problem remains, the doctor or podiatrist may recommend removing part of the nail through surgery. This is called a toenail avulsion.

The doctor will cut away the edges of the toenail, to make it narrower. They may also remove the folds of skin on either side of the toenail. If it is done under a local anesthetic, the patient will be awake but the area is numbed, so they will not feel anything. In some cases, a general anesthetic may be necessary.

If the nail has become very thick or distorted, the whole nail may be taken out, again under a local anesthetic.

This is not usually very painful, and most people can get back to normal the next day.

Permanent removal

If the ingrown toenail keeps coming back, the cells in the nail bed may be removed so that the toenail cannot grow again.

These cells may be destroyed using a chemical called phenol, or another method, such as laser.

Although the doctor will use a local anesthetic, the toe may feel tender when the anesthetic wears off. Ibuprofen or acetaminophen, for example Tylenol, or paracetamol, may help.