Ingrown toenail

An ingrown toenail develops when the edge of a toenail invades the surrounding soft tissue. This invasion leads to painful inflammation and the potential for a secondary infection.


Causes/associated factors
Ingrown toenails are most common with the big toe. Contributing factors may include:
tight, poorly fitting shoes
excessive sweating of feet
unusually curved or improperly trimmed toenails
trauma to the toe
participation in activities that involve sudden stops
congenital misalignment of the toenail

Signs/symptoms
An ingrown toenail causes pain near the corner of the toenail, as well as redness and swelling near the toenail and surrounding tissue. If an infection develops, you may notice increased pain, redness, heat, pus drainage or fever.

Diagnosis
Diagnosis is based on symptoms and a physical exam. X-rays aren't typically necessary unless the doctor wants to further evaluate an associated condition.

Treatment
If you have diabetes, peripheral vascular disease or a weak immune system, it's essential to consult your doctor or podiatrist immediately. For otherwise healthy adults, uninfected ingrown toenails can often be treated at home. Consider the following suggestions:
Soak your foot in warm water every day. Dry your foot well after each soaking.

Roll up a small amount of cotton into a small wick and place it between the nail and the nail bed. Change the cotton every day.

Wear shoes that allow your toes to spread normally when you walk and don't place pressure on your toes. Open-toed shoes may be a good choice. It's also a good idea to rotate your shoes.

Keep the area clean and dry.
If these measures aren't effective or you suspect an infection, consult your doctor. Antibiotics may be prescribed. In some cases, part of the nail may be removed to keep it from invading the surrounding tissue. Or, if there is severe distortion after repeated infections, the nail and nail bed may be removed entirely. If skin has overgrown the nail, the doctor may use a technique that allows the nail to be left in place.


Complications
An ingrown toenail may lead to recurrent infections that require surgical treatment. If you have a weak immune system, diabetes or peripheral vascular disease, it may be more difficult to restore the healthy tissue. The risk for more serious complications is also higher, including cellulitis, ulceration and possible death of the toe tissue. Rarely, this could lead to amputation.

Pregnancy-specific information
Pregnancy is not a risk factor for ingrown toenails.

Senior-specific information
For older adults, toenail problems often involve bent, curved or thickened nails with associated fungal infections. Because the immune system may be less effective with age (often due to chronic disease and illness), older adults tend to be more susceptible to infections. Impaired circulation -- also more prevalent with age -- affects healing, especially in the extremities.

Prevention
To prevent ingrown toenails, consider the following suggestions:
Don't cut your nails too short. Trim them straight across rather than curved to the shape of your toes. If your toenails are thickened or deformed, have them trimmed by a trained professional.
Avoid picking your nails and creating sharp edges and irregularities.
Wear properly fitting shoes and socks.
It's also important to monitor your foot health regularly, especially if you have an impaired immune system, circulatory problems, nerve damage, impaired sensation or diabetes. Recognizing early signs of problems and taking appropriate action can help prevent serious complications.