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What is an ingrown toenail?

The nail becomes ingrown when the side of the nail cuts into the skin next to the nail. This can become painful. The skin next to the nail may also become infected or inflamed.

Any toe can be affected but it is usually the big toe. Ingrowing toenails are a common problem, especially in teenagers and young adults. However, ingrown toenails can also occur in babies or toddlers.

An ingrown toenail is usually caused by a sharp spike of nail growing into the skin beside it.

This can happen as a result of various factors, including:

• Not trimming your nails correctly.

• Wearing poorly-fitting shoes.

• Wearing tight socks.

• Sweating a lot.

• Deformed nails.

• Injury to the toenail.

• Fungal infection of the toenail.

• As a side-effect of the medication isotretinoin.

Shoes which force the toes towards each other encourage the nail to grow into the skin. For example, tight shoes, high heels and pointed-toe shoes. Additionally, active, sporty people may be more prone to ingrown toenails as they sweat more.

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Early on, the skin around the ingrown nail may become reddened and feels slightly tender. If it progresses and becomes infected, it may become more swollen, red and painful.

If the infection gets worse, there may be some fluid (pus) oozing from around the nail. Ingrown toenail pus is usually yellow or green. The nail will become even more painful and there may be an overgrowth of skin around it.

If the ingrowing part of the nail is small, a non-surgical fix may be possible. It may be prevented from becoming worse, and sometimes cured, by the following. This treatment may be given by a podiatrist or other healthcare professional, or you may be shown how to do it yourself.

• Soak the toe in water for 10 minutes to soften the folds of skin around the affected nail.

• Then, using a cotton wool bud, push the skin fold over the ingrown nail down and away from the nail. Do this starting at the root of the nail and move the cotton wool bud towards the end of the nail.

• Repeat each day for a few weeks, allowing the nail to grow.

• As the end of the nail grows forward, push a tiny piece of cotton wool or dental floss under it to help the nail grow over the skin and not grow into it. Change the cotton wool or dental floss each time you soak your foot.

• Do not cut the nail but allow it to grow forward until it is clear of the end of the toe. Then cut straight across the nail, and not rounded off at the end.

There are variations on this method - the principle is to keep the skin from growing over the edge of the nail.

Infected ingrown toenails

If the nail fold becomes infected, symptoms of infection are increasing pain, swelling and redness near the ingrown nail, and yellow or green pus near the nail or under the nearby skin. If the infection is getting worse, you may have a throbbing pain, redness spreading over the toe, or a high temperature (fever).

Antibiotics may be needed to treat infection. It can also help to soak your feet in warm salty water, then carefully dry your feet.

Severe ingrown toenails are usually treated by a GP or nurse, or a person qualified to diagnose and treat foot disorders (a podiatrist). In some cases, surgery is helpful.

Contact a doctor if:

• You have persistent and troublesome symptoms from the ingrown nail.

• You have symptoms of infection (as above). If you also have diabetes or a poor immune system (immunosuppression), see a doctor urgently, as infections will need treating quickly.

• You have a condition affecting the nerves or feeling (sensation) in your foot. For example, if you have loss of feeling due to diabetes (diabetic neuropathy) affecting the feet. This is because a loss of sensation or nerve damage can make you unaware of problems in the foot, such as a deep infection. So, you will need careful assessment and monitoring. You may be referred to a foot clinic or a podiatrist.

For persistent ingrown toenails

Removing part of the nail may be necessary. This is usually done by a podiatrist. The usual procedure is as follows:

• Local anaesthetic will be injected into the base of the toe to make the procedure painless and numb the toe.

• The toenail is then cut with scissors longways a few millimetres in from the offending edge.

• It is cut right up to the base of the toenail and the offending edge can then be pulled out.

• A small amount of acid (called phenol) is often put on the exposed part of the nail bed. This helps to stop the edge of nail regrowing and causing another ingrown nail.

• The nail is then dressed.

Once the anaesthetic wears off, the toe may be sore so you may need mild painkillers such as paracetamol for a day or so. You will probably have to wear a bandage for about two weeks. During this time you will not be able to have a bath or go swimming. You also will not be able to do any strenuous exercise, such as running. After the procedure, the nail will regrow but will be narrower than before.

• Cut your nails straight across; do not cut your toenails too short or too low at the sides. The corner of the nail should be visible above the skin. (Tip: it is easier to cut nails after a bath or shower, when they are softer.)

• Keep your feet clean and dry. Let air get to your toes when possible.

• Wear shoes that fit properly - avoid tight shoes and use cotton socks rather than synthetic.

• If you have diabetes, you should take extra care when cutting your nails:

  • Cut the nail straight across or follow the shape of the end of the toe, but be very careful not to cut too low at the sides of the nail.

  • Gently file any sharp edges with a nail file.

  • If you have any loss of feeling in your feet, you should visit a podiatrist to have your nails trimmed, rather than doing it yourself.

  • If you can't see your feet or nails very well, you should visit a podiatrist to have your nails trimmed, rather than doing it yourself.