What are Ingrown Toenails?

An ingrown toenail is a toenail that begins growing or digging into the skin at the side edge or the terminating end of the toe. This is a painful condition that usually comes with redness and slight swelling at the point where the toenail is growing inward. The medical term for an ingrown toenail isunguid incarnates (also onychocryptosis).

Although ingrown toenails can afflict any of the toes on the foot (and ingrown fingernails can similarly affect any finger), the most common location for an ingrown toenail to occur is on the big toe. The problem is most common on the outer rather than the inner edge since this is the edge most likely to rub against surfaces when the patient is walking – the outer edge of the toe rubs against the interior surface of the shoe or boot.

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However, it is possible for the inner edge of the big toe, or any toe, to have an ingrown toenail develop. Indeed, it is possible for both edges of the toe to become ingrown simultaneously, though this combination is not considered very common.

ingrown toenail picture

Home treatment is often effective for ingrown toenails, but sometimes the condition can become serious enough to warrant medical attention. In particular, an untreated or stubborn ingrown toenail has the potential to develop an infection; a rare complication in such an instance is an infection of the toe bone itself. This is referred to asosteomyelitis and is a serious condition that may require surgery. Another possible complication of an ingrown toenail is the formation of an abscess.

Symptoms of Ingrown Toenails: Early Stages

The common symptoms of ingrown toenails include a variety of conditions. In the early stages of an ingrown toenail, all of the following are likely to be present:

  • pain
  • redness
  • swelling in the inner or outer corner area of the affected toe

ingrown toenail diagramInitial swelling is likely to be mild, but the patient suffering the ingrown toenail may nevertheless experience a high degree of pain associated with the ingrown toenail. It is not unusual for the pain from an ingrown toenail to be perceived as excruciating, especially when pressure is applied to the area where the toenail is growing inward. In most cases, the patient experiences little to no pain as long as the toe is not in use and external pressure is not being applied.

In these early stages of the condition, the end of the toe will probably be reddened, but there may or may not be warmth associated with the ingrown toenail. If it is, the toe will feel slightly warm to the touch. The patient, on the other hand, will not be experiencing a fever. It is unusual in the early stages for the ingrown toenail to be associated with any sort of drainage, including pus.

Symptoms of Ingrown Toenails: Later Stages

ingrown toenailIf an ingrown toenail is not promptly treated with appropriate care, the condition is likely to worsen. Symptoms that may be present as the problem persists may include all of the following factors.

  • Additional skin and tissue that grows to surround the tip of the nail where the nail tissue forms a sharp surface.
  • After skin and tissue surround the tip of the nail, the area may fill with fluid and begin to drain. In most cases this fluid will be clear and yellowish. Although patients may become concerned at this point that the drainage indicates an infection, this is not usually the case. In most cases, what is happening is that the nail digging into the skin is causing an irritation and the body is taking the natural step of reacting to the intrusion.
  • In some cases, however, an infection actually will occur at this stage. Symptoms of such an infection include:
    • increased drainage
    • drainage of either a whitish or a yellowish shade
    • increased swelling in the area
    • inflamed skin in the area taking on a red hue
    • a patch of lighter colored skin surrounding the inflamed skin

A fever may or may not be present at this stage. In most cases a fever will not be present, but if one is, it may indicate that the infection is serious and should be addressed without delay.

What Causes Ingrown Toenails?

The causes of ingrown toenails are varied; many of them also form causes of other foot disorders such as fallen arches and tightened tendons. The major causes of ingrown toenails include all of the following; however, in most cases only a single cause will be present:

  • wearing high heels: such shoes can cause the foot to be forced into an angle in which the toes are unnaturally compressed. This in turn can encourage a nail to grow in an abnormal fashion, including growing inward instead of outward.
  • wearing shoes that are overly tight: the usual problem here is that the toes end up being smashed against each other, forcing nails to grow at an unnatural angle.
  • medical disorders of the foot, especially the nails: fungus infections in particular can cause the toenail to develop in an abnormal manner. Problems in this case involve both nails that are thicker than normal and wider than expected. In either case, ingrown toenails can result.
  • serious injuries near the toenail, especially sharp cuts in the area
  • repetitive injuries to the toenail, especially blunt trauma injuries such as would be sustained from repeatedly kicking a ball.  The blunt trauma can gradually change the angle of nail growth, causing it to grow inward instead of outward.
  • improper technique when trimming toenails: unlike fingernails, it is generally considered a mistake to round off the surface of toenails. The edge of the nail that is nearest the edge may proceed to grow into the toe surface instead of growing up and outward. The proper technique for trimming toenails is to cut them in a straight line perpendicular to the toe, and then use a nail file or emery board to buff out any rough spots resulting from the cut.
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 Risk Factors for Ingrown Toenails

Although not strictly a cause, genetic factors also play a role in the development of ingrown toenails. Some people are simply more susceptible to toenails that form in a less than optimal manner. If any member of your immediate family has experienced a great deal of difficulty with ingrowing toenails, it is unfortunately likely that you will also experience problems. The base issue is that some people simply have nails that naturally take on a more rounded than square shape. It is this shape that makes ingrown toenails more likely.

Other risk factors include age and gender:

  • Ingrown toenails are not common in infants or children.
  • Ingrown toenails are most common in adults that have not yet reached middle age; their highest incidence occurs in the age range 22 – 39.
  • Ingrown toenails occur more frequently in men than in women, despite the fact that it is women who are far more likely to wear high heels and tight shoes, one of the common causes. This suggests that in fact, men are much more susceptible to the condition than are women.

It is not known why age and gender play a role in determining risk levels for the incidence of ingrown toenails.

Treatment for Ingrown Toenails

There are a number of treatments you can pursue that are both effective and cheap. The type of treatment depends on the severity of your ingrown toenail and the symptoms you are experiencing (pain, fever, etc.)

Home Treatments

Home treatment is usually successful at healing ingrown toenails, but if an infection sets in or the ingrown condition is persistent, it is wise to seek professional medical care as surgery or other serious treatment may be required.

The basis of home care consists of keeping the toe clean, particularly the ingrowing nail area, and encouraging the nail to continue growing in the correct instead of the incorrect direction. To these ends, the following steps are recommended:

  • Wash the entire foot including the ingrown toenail area at least twice each day, using soap and warm water. Dry thoroughly after each washing. In between washings, take care to keep the foot both dry and clean so that infection is less likely to take hold in the wounded area around the ingrown toenail.
  • Soften the tissue around the ingrown toenail by soaking the affected toe (and the whole foot if convenient) several times each day. Use warm water and soak for at least ten minutes each time. This will help to make the toe tissue soft enough that the next step becomes more feasible.
  • Using a sterile stick and gauze (both available at more pharmacies), gently insert a small section of gauze underneath the toenail near the edge where it is ingrowing. Nudge the gauze section over until it rests beneath the ingrowing portion of the toenail. The goal is to lift the toenail up slightly in order to encourage it to grow in the correct direction instead of continuing to dig further into the skin. This part of the home treatment is likely to be quite painful, but soaking the foot thoroughly in advance will help to some degree. The use of an NSAID pain reliever such as ibuprofen or aspirin, or other pain relief medication such as Tylenol, may also be helpful, although nothing will eliminate the pain entirely.
  • The gauze dressing should be changed at least once each day in order to help prevent infection. Each time it is replaced, make an effort to move it over a little more, thus elevating the toenail more as time goes on. After one to two weeks have passed, the nail should have grown out enough that visible results can be seen and the ingrowing condition is largely healed.
  • Avoid shoes that will compress the toes; they might push the toenail back into an ingrowing position. Going barefoot or wearing open toed shoes such as sandals is the best option while treatment is ongoing. If closed toes shoes must be worn, make sure the toe box is not constricted. Avoid high heels as these tend to compress the toes.

Doctor’s Treatments

If you see signs of an infection, even if home care is already underway, seek the advice of a health care professional. Common signs of an infection include:

  • increased swelling
  • pale skin surrounded by much redder skin
  • excessive drainage
  • fever

You should also see a doctor if home care has produced no improvement after five days or if you are not fully immunized against tetanus. Adults should have a tetanus booster shot at least every ten years; some infectious disease experts recommend a booster schedule of every five years. Tetanus is a serious condition so if you are not fully vaccinated against it and you have an ingrowing toenail, do not delay seeing a doctor.

Other reasons to seek medical care include instances where you know you have a condition that impedes effective healing of wounds or makes infections more likely. Such conditions include but are not limited to

  • AIDS (Acquired Immune Deficiency Syndrome)
  • poor circulation
  • diabetes
  • cancer(s) currently being treated by means of chemotherapy.

Depending on the severity of the ingrown toenail and other health related factors, the doctor may recommend a course of treatment that is quite similar to the home treatment described above. However, he also has access to other options, such as a splint. The purpose of such a splint is to keep the sharp edge of the nail from making contact with the skin. Splints may consist of tubes or strips made of plastic, or insertions of cotton; even materials like resin are sometimes used.

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Another medical option is for the doctor to perform a procedure that involves snipping the toenail in the center to try to influence how it will continue to grow.
The most invasive medical treatment option involves actual surgery. Sometimes this is as simple as a removal of some of the extra flesh that may surround the ingrown toenail. At other times it may become necessary to remove the toenail itself, either in whole or part. This is most likely to be warranted when a serious infection has set in. Such a procedure can be an outpatient procedure that takes place in a doctor’s office, but at times it may need to take place in a hospital setting.