Ingrown toenail

An ingrown toenail is very common. It usually involves the distal corner or the side of a toenail, causing pain, red, swollen skin inflammation, and even infection. The big toe is most often affected.

Most of the time, ingrown toenails can be resolved with self-care. However, if the inflammation expands or the pain is more intense, seeing a doctor can help relieve the pain and reduce the chance of infection.

A diabetic patient or conditions causing poor blood flow to the feet has a higher risk of infection.

Symptoms

• Pain
• Skin becomes fragile
• Skin inflammation
• Swelling
• Infection

When to consult a doctor

Seek medical attention if experiencing toenail discomfort, pus discharge, or expanding skin inflammation. A diabetic patient or patient known to have poor blood circulation in the foot should seek medical attention, as well as a patient with pain or infection.

Causes

• Wearing shoes that cover and press on the toenails
• Trimming toenails too short
• Toenails injuries
• Arching toenails
• Infections around the nails
• Other medical conditions

Factors that increase the risk of ingrown toenail

• Being a young adult with higher sweating can soften the nails and macerated skin
• Trimming the nail too short or rounding the corners of nails too far
• Lack of nail hygiene
• Wearing shoes that put pressure on toes
• Activities such as running or kicking increase the risk of toe injury
• Diabetes or any condition that causes poor blood flow

Complication

Diabetic patients can have severe complications from an ingrown toenail as they may have poor blood flow and nerve damage. Hence, diabetes patients sustaining minor foot injuries with a cut, scrape, etc., may not be able to mend by themselves, leading to infection.

How to prevent ingrown toenails

• Trim the toenails straight across – Avoid rounding the corners to conform to the shape of the distal toes. Patients with poor blood flow should not trim their nails but should visit a podiatrist to have their nails trimmed regularly.  
• Keep toenails at medium length – Trim the toenails evenly and not too short as too short toenails may facilitate pressure from the shoes to the toes and result in it growing into the toe skin.  
• Wear well-fitting shoes – Tight shoes will put too much pressure on the toes and cause nails to grow into the tissue. Those with nerve damage may lack the ability to sense if the shoes are too tight. 
• Wear protective footwear when engaging in activities that could risk toe injuries, for example, steel-toed shoes.
• Check the feet regularly for signs of ingrown toenails or foot infection if the patient has diabetes.

Diagnosis

The doctor diagnoses an ingrown toenail based on symptoms and inspection of the nail and surrounding skin. 

 Treatment

• Partly remove the nails – For those with severe ingrown toenails presenting with skin inflammation, pus, or pain, the doctor will numb the toe and partially remove the ingrown portion of the nail. The toenail will grow back in about 2 to 4 months.
• Remove the nail and the adjacent tissue – The doctor may advise the patient to partially remove a portion of nails and the nail bed if the patient has recurrent issues with the same toe. This is done under a local anesthetic digital block.

Pain relievers help reduce the pain after the nail extraction procedure. The patient can also apply a cold compress daily until the swollen area has subsided. Elevate the foot for 12 to 24 hours. Avoid swimming and activities that hurt the toe or using a hot tub. Reach out to the doctor if the toes haven't healed.

Conditions sometimes recur, surgery is better at preventing recurrence than nonsurgical procedures. 

Lifestyle changes and self-care tips

• Soak the feet in warm soapy water - Do it 3 to 4 times a day for 10 to 20 minutes until the conditions improve.
• Apply petroleum jelly to the tender area and wrap a bandage around the ingrown toe.
• Wear open-toed footwear or sandals until you feel better.
• Take pain relievers such as acetaminophen or ibuprofen to help reduce the pain.

Preparing for the doctor's appointment

The general medical practitioner or a podiatrist can diagnose ingrown toenails.

Questions to ask the doctor are as follows:

• Are these conditions temporary or chronic?
• What are my treatment options and the advantages and disadvantages of each option?
• What results can I expect?
• Should I wait for the conditions to heal by themselves?
• What nail care routine should I follow?

Questions the doctor may ask are as follows:

• When did you first have these symptoms?
• Do you have it all the time?
• What self-care have you been using?
• Are you a diabetic or have a health condition that causes poor blood flow to the feet?