Ingrown toenail

An ingrown toenail can occur due to a number of causes. 

• Badly cut toenails – cutting  your toenails too short or into the corners can break the natural skin barrier. This increases the risk of infection and allows your skin to fold over the nail edge and your nail to grow into it. 
• Increased pressure from tight shoes, socks or tights.
• Foot injuries – ingrown toenails can appear after injuring your toe.
• Sweaty feet.
• Fungal nail infections can cause a thickened or widened toenail.
• Genetics and natural toenail shape – toenails that are more curved or fan-shaped are more likely to press into the sides.
• Medicines such as isotretinoin.

Typical symptoms include: 

• a red and painful edge of the skin around your toenail
• pain in that area when wearing shoes due to pressure on your toe
• a raised area along the toenail edge from an overgrowth of skin.

If your ingrown toenail gets infected, your toe can become more swollen and the pain and redness can get worse, and sometimes blood or pus can be seen.

Diagnosis

Your doctor will ask you questions about your symptoms and examine your toe to see if it is infected. Usually no tests are needed to diagnose an ingrown toenail, other than a possible swab test.

Treatment

Video: How to Treat an Ingrown Toenail

Here's a video on how to treat an ingrown toenail. This video may take a few moments to load.

(WebMD, US, 2017)

Treatment of an ingrown toenail consists of self-care measures and may involve antibiotics or minor surgery. 

Your GP will first recommend self-care measures to help relieve your symptoms, such as:

• soaking your foot in warm water 3 to 4 times a day for a few days – this will help soften the skin around your toe and stop your nail growing into it
• adding a mild antiseptic to the soaking water or adding cider vinegar (1 quarter cup per basin)
• keeping your foot dry at other times
• wearing well-fitting and comfortable shoes
• taking pain relief medicines such as paracetamol or ibuprofen to relieve your pain – check with your GP or pharmacist whether you can take them
• not cutting or picking at your toenail – instead allowing it to grow out so it is easier to cut it straight across
• if pus can be seen, swabbing that area with antiseptic or methylated spirit to clear away the pus.

There are many devices available from your pharmacy (eg, Scholl’s toe protector) or online. These are designed to ease pressure on the affected toe. They are inexpensive.

If your symptoms don’t improve after self-care measures, or if your ingrown toenail is infected, your GP may prescribe antibiotics. Any material oozing from that area may be tested in the laboratory to help your GP prescribe the correct antibiotic.

Your GP or podiatrist may also perform minor surgery to remove your whole nail or cut away part of your nail. This procedure can be done in their consulting room using local anaesthetic. Discuss these options with your GP.

You can help prevent an ingrown toenail with the following measures: 

• Take care when cutting your toenails. Cut straight across, not too short and not into the corners or edges.
• Wear comfortable, well-fitting shoes or sandals.
• At work, wear steel-booted footwear, where appropriate.
• Avoid tight socks and change them every day, or as soon as your sport or exercise is over. 
• Wash your feet every day, dry well and apply moisturiser to dry skin. 

Other than your GP, a podiatrist can help assess your foot and advise the best treatment options for you. Find a local podiatrist(external link) Podiatry NZ.