Ingrown Toe Nails

Ingrown Toenails

An ingrown toenail is a condition that occurs due to abnormal growth of the sides and corners of the toenail into the soft flesh. It is a common condition but can be painful, which causes swelling and redness. It affects the big toe, either on one side or both sides.

These can be treated easily at home, but if your ingrown toenail gets infected and you have other underlying medical conditions (e.g., diabetes), you may need to see a podiatrist (foot specialist) for the treatment. However, ingrown toenails can be prevented by taking precautionary steps.

To know more about the causes, symptoms, diagnosis, treatment, and prevention, consult Dr. Priyanka Reddy at DNA Skin Clinic and Wellness Centre, Bangalore.

Who is Likely to Have Ingrown Toenails?

Anyone can get an ingrown toenail. But you have a higher risk if you:

  • Are an adolescent

  • Are an athlete

  • Have sweaty feet

  • Are a diabetic (high blood sugar)

  • Have severe nerve damage in the leg or foot

  • Have an infection around the nail

  • Have poor blood circulation


What Causes Ingrown Toenails?

It is a condition in which the corner or side of a toenail grows into the flesh. It usually affects you if you have big toes and sweaty feet.

However, the other significant causes of ingrown toenails include:

  • Cutting your toenails too short.

  • Rounding your nail edges.

  • Wearing ill-fitting shoes or tight hosiery that press against your toenail.

  • Injury to your toe due to jamming it against a hard surface.

  • Stress on your toenails due to poor posture or physical activity (ballet, soccer, or running)

  • Family history of ingrown toenails makes you more prone to have ingrown toenails.

  • Congenital (present from birth) - if your nail is too large for your toe.

What Are The Symptoms of Ingrown Toenails?

The symptoms of ingrown toenail include:

  • Hard Swelling - Initially when you have an ingrown toenail, it may be hard, swollen, and tender (painful when touched).

  • Redness- Later the area affected becomes red and feels sore.

  • Pain- It is a painful condition. You may experience mild to moderate pain. It becomes difficult for you to stand or walk due to pain.

  • Warmth- The toe affected feels warm or hot.

  • Bleeding- The inflamed skin around the ingrown toenail can bleed.

  • Infections- It may lead to infections due to bacteria entering through the inflamed soft flesh.

  • Discharge- White or yellow pus can be seen draining from the infected area.

  • Oedema- There may be fluid buildup around the affected area leading to swelling. You may experience difficulty wearing full-coverage footwear.

How Can You Diagnose Ingrown Toenails?

Most often, you can diagnose an ingrown toenail yourself, depending on the signs and symptoms, and the clinical appearance of your toe. You may consult your podiatrist (foot specialist) for a physical examination of your toe. Your podiatrist will examine the skin at the edge of your toenail. Ingrown toenail is diagnosed if your skin is:

  • Growing over the nail.

  • Swollen, red, or tender.

  • Infected with pus discharge.

Generally, you do not require any additional tests or X-rays to diagnose an ingrown toenail. However, you may need an X-ray in rare cases if your toenail is severely infected. You may also require a blood culture test to detect the organism that is causing the infection. This helps to determine what medications are needed to treat the infection.


How Can You Prevent Ingrown Toenails?

As the saying goes, prevention is better than cure. So is the case with ingrown toenails, taking precautionary steps can prevent it. To help prevent an ingrown toenail:

  • Wear shoes that fit properly- tight fitting shoes tend to put a lot of pressure on your toenails which causes them to grow into the soft flesh.

  • Keep your toenails at a moderate length- trim your toenails till the level of your toe, so that the underlying soft skin is not exposed.

  • Trim your toenails straight across your toe- do not round or curve your toenails.

  • Try to wear protective footwear- especially during activities that put you at high risk of injuring your toes.

What Are The Treatment Options For Ingrown Toenails?

Mild cases of ingrown toenails can be treated with home remedies, however severe cases require surgical intervention. Dr Priyanka Reddy, at DNA Skin Clinic and Wellness Centre, Bangalore, recommends the following treatments:

Home remedies

The following treatments help relieve pain, and promote healing of an ingrown toenail.

  1. Soak in warm, soapy water

    1. This reduces swelling and pain.

    2. Adding epsom salts to water brings additional relief.

  2. Soak in apple cider vinegar

    1. Apple cider vinegar has antiseptic and anti-inflammatory and pain-relieving properties.

    2. Take a basin of water and add 1/4th cup apple cider vinegar.

    3. Soak the affected foot for upto 20 minutes daily.

    4. Towel dry the area properly.

  3. Apply antiseptic ointment

    1. This promotes healing and reduces the risk of infection.

    2. Clean the affected area, and dry it well.

    3. Apply the cream at least 3 times daily.

    4. Bandage the toenail after application.

  4. Wear comfortable shoes and socks

    1. Tight shoes and socks can cause crowding of your toes.

    2. Wear footwear that fit and leave space as well.

    3. Use sandals instead of shoes until the toenail heals.

  5. Take an over-the-counter (OTC) pain reliever

    1. Acetaminophen may relieve the pain.

    2. Take in an interval of 4 to 6 hours.

  6. Use a toe protector

    1. It provides a cushioning support to the ingrown toenail.

    2. These are available as rings that fit well around the affected area.

  7. Try a toe brace

    1. These are composite devices which hold the toe in place and protect the skin around.

    2. It treats as well as prevents ingrown toenails.

  8. Use oral antibiotics as prescribed by your doctor.

    1. This relieves pain, swelling and combats the infection.

Surgical Treatment

If the ingrown toenails are not treatable by home remedies, and in severe cases, you may consult your podiatrist for a surgical treatment. The most common surgeries for ingrown toenails include:

  1. Wedge resection/excision

    1. Your doctor removes a portion of your toenail.

    2. This procedure is also called partial nail avulsion.

  2. Toenail removal

    1. Your doctor may remove your entire toenail.

    2. It takes almost 18 months for the removed nail to grow back.

    3. However, this procedure has a higher risk of ingrown toenail in future, because the nail grows back deformed.

    4. This procedure is also called complete nail avulsion.

  3. Surgery on the tip of the toe

    1. Your doctor may remove and reshape the soft tissue at the tip of your toe.

    2. This is recommended when other procedures fail.

  4. Matrixectomy

    1. This procedure involves the removal of the nail bed along with the nail.

    2. This is recommended nail avulsion or wedge resection methods fail.

    3. The types of matrixectomy include:

      1. Phenol matrixectomy

      2. Sodium hydroxide matrixectomy

      3. Laser matrixectomy

      4. Electrosurgical matrixectomy

  5. Zadek’s procedure

    1. It is a procedure which involves removal of your whole toenail, and cutting away the tissue area from where your ingrown nail grows.

What Are The Steps Involved in The Surgical Removal of Ingrown Toenails?

The surgical technique of partial nail avulsion and matrixectomy have shown great success in the treatment of ingrown toenails. It is usually an outpatient procedure at DNA Skin Clinic and Wellness Centre, Bangalore, performed by Dr. Priyanka Reddy.

Before the procedure

  • Your surgeon or podiatrist will take your detailed medical history.

  • A physical examination of the ingrown toenail is done.

  • You must inform your surgeon if you are under medication to avoid any reaction while administering anesthesia.

During the procedure

  • You will be made to lie in a supine position. Your foot will be placed flat on the operating table, or can hang off the tables’ end.

  • The affected area is cleaned with an antiseptic solution.

  • You may be given a local anesthesia (you may remain awake, but the doctor numbs the area so that you cannot feel your toe). Some doctors may use a sedative or a twilight anesthesia (you remain awake but are confused, and may not remember the procedure).

  • A portion of the toenail or complete toenail is removed with a surgical blade.

  • An incision (cut) is made to remove the nail bed.

  • Pus is drained if the affected area is infected.

  • The dead tissue is removed thoroughly by scrapping it out (debridement).

  • The wound is packed with a gauze and left open without any stitches.

  • Bleeding is controlled with a surgical cautery device.

  • Place a mild acid (phenol) to the nail bed to prevent the recurrence of the ingrown toenail.

After the procedure

  • You may take mild pain killer after your procedure to ease pain.

  • Wet compression is used to reduce the post surgical swelling around the operated toe.

  • Rest well and elevate your toe for 12 to 24 hours.

  • Do not engage is activities that injure your toe until your surgeon allows you.

  • Avoid swimming and using hot tub.

  • Keep the bandage/dressing for atleast 1 week after the procedure.

  • Wear loose-fitting shoes for atleast 2 weeks after the procedure.


A word from DNA Skin Clinic and Wellness Centre, Bangalore

Ingrown toenail is a common foot condition affecting 2 out of 10 people. Even though it is a minor condition, it can sometimes lead to severe infection and progress rapidly. This causes severe pain, swelling, redness, and inability to stand or walk. Home remedies provide relief for mild ingrown toenails, but severe cases require surgical removal. Visit Dr. Priyanka Reddy, at DNA Skin Clinic and Wellness Centre, Bangalore, for proper evaluation, early detection, and prompt treatment of ingrown toenails.

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