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Ingrown toenail

Published by Bupa's health information team, May 2009.

This factsheet is for people who have an ingrown toenail, or who would like information about it.

An ingrown toenail occurs when the edge of your nail grows down into your skin. This can cause your toe to become red, swollen and tender.

• What is an ingrown toenail?
• Symptoms of ingrown toenails
• Complications of ingrown toenails
• Causes of ingrown toenails
• Diagnosis of ingrown toenails
• Treatment of ingrown toenails
• Prevention of ingrown toenails
• Questions and answers
• Related topics
• Further information
• Sources

What is an ingrown toenail?

An ingrown toenail occurs when the edge of your toenail grows down and cuts into the surrounding skin. Your big toes are most likely to be affected. Ingrown toenails can occur on just one, or both, sides of your toe.

Ingrown toenails are fairly common, particularly in teenagers and young adults.

Symptoms of ingrown toenails

You may not have any symptoms to begin with. Eventually your ingrown toenail will become painful, especially if you put pressure on the area. The skin around your toenail will become red and swollen and may feel warm.

Complications of ingrown toenails

It's possible that your ingrown toenail may become infected. If it becomes infected it will be painful, red and swollen and there may be some discharge coming from it. There may also be some blisters around your nail that are filled with pus. The infection can spread to the rest of your toe if it isn't treated.

Causes of ingrown toenails

There are several things that can cause, or contribute to, an ingrown toenail.

• Wearing shoes that don't fit you properly. If your shoes are too tight they can force the skin surrounding your toenail against the nail.
• Cutting your toenails incorrectly. Cutting your nails too short and into a curved shape can make them more likely to grow into your skin.
• An injury to your toenail. An injury can leave your toenail deformed, making it more likely to grow into your skin.
• Fungal nail infections. Fungal nail infections can thicken and distort your toenails. This can make them more likely to grow into your skin.
• If you're very sporty or active, you're more likely to get an ingrown toenail. This is because your feet will sweat more, making your skin softer and easier for your nails to grow into.
• If you have inherited fan-shaped nails, you're more likely to get an ingrown toenail.

Diagnosis of ingrown toenails

Your GP will examine your nail and the skin around it. He or she may refer you to a podiatrist (a health professional specialising in conditions that affect your feet).

Treatment of ingrown toenails

Self-help

If your ingrown toenail isn't too painful, gently lift the edge of the nail away from your skin and place a small piece of cotton wool underneath it. The cotton wool will force your nail to grow over your skin rather than into it. Replace the cotton wool every day, and keep a piece underneath your nail until it has grown beyond the flesh of your toe.

If lifting the edge of your nail is too painful, try soaking your foot in warm water first. This will help to soften your nail and make lifting the edge less painful.

Keep your foot clean and dry, and try to rest it as much as you can. If your toe is very inflamed (swollen), elevating your foot may help.

Medicines

If you're in a lot of pain, taking over-the-counter painkillers, such as ibuprofen, should help. Always read the patient information leaflet that comes with your medicine and ask your pharmacist for advice if you have any questions.

If your toenail becomes infected, your GP will give you some antibiotics to take.

Non-surgical treatment

If your ingrown toenail isn't too severe, it can usually be trimmed by your GP or podiatrist. He or she will lift the edge of your nail and cut away the ingrown section.

If you're waiting for treatment from your GP or podiatrist, you can relieve the pain and discomfort in the meantime by bathing your foot in warm, salty water. This will help to reduce the inflammation and prevent your nail from becoming infected.

Surgery

If your ingrown toenail is severe, you may need a small operation to remove it. You will be given an injection of local anaesthetic before the procedure. This will numb the area so you won't feel any pain.

Your toe will be cleaned with antiseptic. A cut will be made lengthways into your nail, and around a quarter of it will be removed. Sometimes your whole nail is removed rather than just part of it.

You may also have your nail bed (the cells from which your nail starts growing) removed. This will stop the edge of your nail re-growing and growing back into your skin. Your toenail will be narrower when it grows back. This can be done surgically or with the application of a chemical called phenol.

After your operation, your toe will be covered with a dressing. You will be given advice about how to keep your wound clean while it is healing, and your surgeon may prescribe antibiotics for a few days.

Prevention of ingrown toenails

To prevent an ingrown toenail, cut your nails straight across rather than as a curve with short edges. Use clean, sharp nail trimmers. Your nail edge should extend past the flesh of your toe.

Wear shoes that are wide enough for your feet and that don't apply any pressure to your toes. This will allow your toes to spread out a bit while you're walking. Try not to wear shoes with narrow, pointed toes.

Keep your feet clean and dry. Wash your feet every day and change your socks or tights every day.

Related topics

• Fungal skin infections

Further information

• British Orthopaedic Foot & Ankle Society
  www.bofas.org.uk

Sources

• Beers MH, Fletcher AJ, Porter R, et al., The Merck Manual of Medical Information. New York: Pocket Books, 2003: 409
• Toenails, Ingrown. Benzoni TE. www.emedicine.com, accessed 25 November 2008
• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2005: 565
• Ingrowing toenail. GP Notebook. www.gpnotebook.co.uk, accessed 17 November 2008
• Ingrown nails. Ann G Egland. www.emedicine.com, accessed 25 November 2008
• Ingrown toenail. DynaMed. www.ebscohost.com/dynamed/, accessed 25 November 2008
• Ingrowing toenails. The Society of Chirpodists and Podiatrists. www.feetforlife.org, accessed 10 November 2008
• Youngson DR. The Royal Society of Medicine Health Encyclopedia. 2nd ed. London: Bloomsbury Publishing Plc, 2001: 411
• Rounding C, Bloomfield S. Surgical treatments for ingrowing toenails. Cochrane Database of Systematic Reviews. 2003, Issue 1. Art. No.: CD001541. DOI: 10.1002/14651858.CD001541.pub2
• Zuber TJ. Ingrown toenail removal. Am Family Physician 2002; 65:2547-50

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content in intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: May 2009