Ingrown Toenails: Infection, Causes, Prevention, Surgery

An ingrown toenail can develop in two ways. Sometimes the nail grows into surrounding skin. At other times, the skin grows over the edge of the nail. Ingrown toenails commonly occur as a result of trimming toenails with tapered edges instead of cutting nails straight across. As the nail begins to grow, it may curl under and dig into the skin or the skin may infringe upon the nail. The skin around an ingrown toenail may be red and swollen, causing pain. Severe cases may ooze pus.

Ingrown toenails most commonly result from trimming toenails in the wrong way. Rounding the edges of toenails instead of cutting them straight across creates areas that may later grow into your skin. Shoes that are too tight, especially in the toe box, can also encourage curved nail growth into your skin. A person's posture, gait, and any structural abnormalities of the feet (hammertoes, bunions, foot pronation) may also make ingrown toenails more likely. Having broken, brittle toenails may leave you with sharp nail edges that can grow into skin.

Ingrown toenails cause redness and swelling around the affected toe area. The site may be painful to the touch. An infection may develop if the condition progresses, and the area may ooze pus. Treating ingrown toenails as soon as possible reduces the risk of both infection and the possibility of needing foot surgery. The question on most people's minds after recognizing that they have this condition is, "How do you get rid of ingrown toenails?"

Several over-the-counter treatments are available for ingrown toenails. These topical nail products may contain botanical ingredients like menthol and tea tree oil to decrease inflammation. Other topical agents may contain salicylic acid, which relieves pain and softens nails. Over-the-counter remedies should not be used by those who have diabetes, poor circulation, or a foot infection.

Do:

• Try to coax a stuck toenail out from beneath overgrown skin by soaking the affected foot three to four times a day.
• Dry the foot well and wear comfortable shoes that do not crowd the toes until the area is healed.
• Insert a very small wad of cotton or waxed dental floss between the nail and the skin to encourage separation. Change the packing material every day.
• Take over-the-counter pain relievers like acetaminophen or ibuprofen to minimize discomfort.

It's important to seek medical treatment if the condition becomes worse or doesn't improve with home treatment within two to three days.

Do NOT:

• Fall for the home treatment that alleges an ingrown toenail can be cured by cutting a V-shaped wedge into the top of the nail. Proponents claim this encourages nail growth toward the center of the nail, instead of at the sides where the problem is located. This simply isn't true. All nail growth occurs from the base of the nail toward the top of the toe.
• Attempt surgery at home. The skin around your ingrown toe is irritated, and possibly infected. Attempting to cut into the area at home puts you at risk of further complications, and may force you to visit the ER for additional medical treatment.
• Cut your nails down to the nailbed. If your nails are cut too short, this can make it easier for your toenail to grow into the surrounding skin.

When home remedies aren't enough to treat an ingrown toenail or the condition is associated with severe pain or infection, surgery may be necessary. Depending on the extent of the problem, a doctor may remove part of the nail, part of the affected nail bed, and some of the surrounding affected tissue. In extreme cases, the doctor may remove part of the growth center (matrix) from which the nail grows. This may be done surgically, or with the application of the chemical phenol.

After ingrown toenail surgery, treat the affected toe and foot with care. Apply antibiotic ointment and take over-the-counter pain medication as directed by your doctor. Keep the surgical area dry and dress the wound as directed. Ask the doctor when it is okay to bathe and follow the doctor's directions. For at least the first two weeks after surgery, wear tennis shoes or other comfortable footwear. While healing, avoid strenuous physical activities like running. Notify the doctor if increased drainage, redness, swelling, or pain develops.

Proper foot and nail care are key to preventing an ingrown nail. Tight or otherwise ill-fitting shoes are common causes of ingrown toenails. Reduce the shoes in your closet and discard high heels and shoes that are too tight, especially in the toe area. Wear sandals when you can and wide-toed shoes to minimize your risk.

One of the best ways to decrease the risk of ingrown toenails comes from wearing appropriate shoes. Feet swell during the day, so it's best to shop for shoes later in the day when feet are at their largest. Choose shoes that have shock-absorbing soles that help reduce pressure on the feet, especially the toes. Breathable materials, such as leather and canvas, are best. Wear shoes with socks to minimize friction and cushion feet.

Properly tending to your toenails today is the best way to prevent ingrown toenails tomorrow. Trim toenails in a way that minimizes the risk of developing ingrown toenails. Cut toenails straight across with a clipper. Do not attempt to shape toenails into an oval shape. This leaves rounded nail edges that may later grow into the skin. Don't trim toenails too short. Toenails serve a function to help protect the toes. If toenails are hard to trim, soak feet in warm water first to soften them. There are also over-the-counter creams containing lactic acid or urea that make nails softer and easier to trim.

While anyone can develop an ingrown toenail, some people are at greater risk than others. People who fall into these categories have an elevated risk:

• People with a family history. If close family members get ingrown toenails, you may face a greater genetic risk as well.
• People who get pedicures. Lots of people get pedicures, both women and men alike. But if your beautician is too heavy-handed at trimming, this can cause ingrown toenails.
• People who sweat more than usual. It's called "hyperhidrosis." Excessive sweating can lead to ingrown toenails.
• People with poor blood circulation. This can increase your risk. Some common culprits of poor circulation include heart disease, tobacco abuse, and diabetes.
• People with obesity. Carrying around more bodyweight can drive nails deeper into skin as you step.
• Young people. Teenagers' feet sweat more than the average person. That makes both their skin and nails softer, and can cause them to split more easily.
• Seniors. Nails thicken as we age. Caring for nails can be more difficult too, due to mobility and vision problems. This sometimes leads to chronically ingrown toenails in older adults.