Overview

An ingrown toenail occurs when the edge of a toenail grows into the surrounding skin, causing pain, swelling, and sometimes infection. It is most commonly seen in the big toe but can affect any toe. Ingrown toenails are a frequent foot problem that affects people of all ages and can range from mild discomfort to severe pain and infection. While some cases can be managed at home, persistent or infected ingrown toenails may require medical attention. With proper care, most people recover quickly and can prevent recurrence through simple foot care practices.

Causes

Several factors contribute to the development of ingrown toenails, including:

• Improper Nail Trimming: Cutting toenails too short or rounding the edges encourages the nail to grow into the skin.
• Tight Footwear: Wearing shoes that squeeze the toes can force the nail to dig into the skin.
• Trauma or Injury: Stubbing the toe, dropping something on it, or repetitive pressure from sports can trigger ingrown nails.
• Genetic Factors: Some people inherit a tendency to develop curved or thick toenails, making them more prone to ingrown nails.
• Poor Foot Hygiene: Not keeping the feet clean and dry can contribute to nail and skin problems.
• Nail Disorders: Fungal infections or other nail diseases can alter nail growth and lead to ingrown toenails.

Symptoms

The symptoms of an ingrown toenail vary based on severity but typically include:

• Pain and Tenderness: Discomfort along one or both sides of the affected toenail, especially when pressure is applied.
• Redness and Swelling: Inflamed skin around the nail where it grows into the flesh.
• Warmth: The area may feel warm due to increased blood flow from inflammation.
• Infection: Pus, drainage, and increased pain may indicate a bacterial infection.
• Overgrowth of Skin: In chronic cases, extra skin may develop around the nail, further worsening the condition.

Diagnosis

Diagnosing an ingrown toenail is straightforward and usually does not require any tests:

• Physical Examination: A healthcare provider examines the toe for signs of nail penetration into the skin, redness, swelling, or discharge.
• Infection Assessment: The presence of pus or spreading redness may prompt evaluation for bacterial infection.
• Medical History: Doctors may ask about foot care habits, footwear choices, and previous occurrences.
• No Imaging Usually Needed: X-rays are only used if there is suspicion of bone involvement or recurring ingrown nails.

Treatment

Treatment depends on the severity of the ingrown toenail and whether infection is present:

• Home Care for Mild Cases: Soaking the foot in warm water, gently lifting the nail edge, and applying antiseptic cream may resolve early cases.
• Footwear Adjustment: Wearing open-toed or roomy shoes can reduce pressure on the affected toe.
• Antibiotics: Topical or oral antibiotics may be prescribed if there are signs of infection.
• Partial Nail Removal: In moderate to severe cases, a doctor may remove part of the nail under local anesthesia to allow the area to heal.
• Complete Nail Removal: Rarely, if the problem is persistent, the entire toenail may be removed, or the nail root treated to prevent regrowth (matrixectomy).
• Follow-Up Care: Keeping the foot clean, changing dressings, and follow-up visits may be necessary after medical treatment.

Prognosis

The prognosis for ingrown toenails is generally very good:

• Excellent Recovery: Most people recover quickly with proper treatment, especially when addressed early.
• Low Risk of Complications: With prompt care, serious complications like deep infection are rare.
• Recurrence Possible: Ingrown toenails can recur, particularly if the underlying cause (e.g., improper trimming or tight shoes) is not corrected.
• Preventive Measures Effective: Regular proper nail trimming, good foot hygiene, and wearing well-fitted shoes can prevent future cases.

Early recognition and care are key to avoiding discomfort and complications from ingrown toenails, allowing most individuals to return to normal activities quickly.