Ingrown Toenail – Causes, Symptoms, Treatment

When a toenail is ingrown, the nail is curved downward and grows into the skin, usually at the nail borders (the sides of the nail). This “digging in” of the nail irritates the skin, often creating pain, redness, swelling, and warmth in the toe.

If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odor. However, even if your toe isn’t painful, red, swollen, or warm, a nail that curves downward into the skin can progress to an infection.

Often, you can take care of ingrown toenails on your own. If the pain is severe or spreading, however, your doctor can take steps to relieve your discomfort and help you avoid complications.

If you have diabetes or another condition that causes poor circulation to your feet, you’re at greater risk of complications from an ingrown toenail.

Causes

While many things can cause ingrown toenails, the major causes are shoes that don’t fit well and improperly trimmed nails. Shoes that are too tight press the sides of the nail and make it curl into the skin. Nails that are peeled off at the edge or trimmed down at the corners are also more likely to become ingrown.

Causes include:

1. bad maintenance [like cutting the nail too short, rounded off at the tip or peeled off at the edges (versus being cut straight across)];[1]

2. ill-fitting shoes [those that are too narrow or too short can cause bunching of the toes in the developmental stages of the foot (frequently in those under 21), causing the nail to curl and dig into the skin];

3. trauma to the nail plate or toe [which can occur by stubbing the toenail, dropping things on the toe and ‘going through the end of your shoes’ during sports, can cause the flesh to become injured and the nail to grow irregularly and press into the flesh]

Symptoms

An ingrown toenail occurs when part of the nail curves into the flesh of the toe . It can occur on all toes but affects the big toe. If dirt and sweat enter the infected area that causes the skin of the nail to become red, swollen, and tender. A small amount of pus will come out of the edge.

Early in the course of an ingrown toenail, the end of the toe becomes reddened and painful with mild swelling. There is no pus or drainage. It may feel warm to the touch, but you may not have a fever.

Treatment

When the problem is mild, you may only need to soak your foot in warm water for 15 to 20 minutes and place dry cotton, such as part of a cotton ball, under the corner of the nail. Signs that the problem is getting worse include increasing pain, swelling and drainage of the area. Sometimes minor surgery is needed to remove the part of the nail that is poking into the skin.

Various over-the-counter preparations are available that can harden the skin and shrink the soft tissue along the edge of the nail so it grows normally. A soft, foam toecap can be worn while the ingrown nail heals.