Ingrowing Toenails (Ingrown Toenails)

What is an ingrowing toenail?

The nail becomes 'ingrowing' 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. It is a common problem, especially in teenagers and young adults.

What causes ingrowing toenails?

Usually there is no apparent reason why it occurs. Tight fitting shoes may be a cause in some cases. It is also more common in people who cut their toenails very short and 'round'. The correct way of cutting nails is 'straight across' (see below). This helps the nail to grow normally and may prevent ingrowing toenails from developing. Other possible causes are injury to the nail, a fungal infection of the nail, or possibly, medication such as isotretinoin.

What is the treatment for an ingrowing toenail?

Ingrowing toenails are usually treated by a GP or a podiatrist (chiropodist). In some cases, surgery is helpful.

If caught early

If the 'ingrowing' part of the nail is small, it may be prevented from becoming worse, and sometimes cured, by the following. This treatment may be given by a podiatrist or GP, 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 under it to help the nail grow over the skin and not grow into it. Change the cotton wool daily.
• Do not cut the nail but allow it to grow forward until it is clear of the end of the toe. Then cut it straight across 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.

If the nailfold becomes infected

Symptoms of infection are: increasing pain, swelling and redness near the ingrowing nail, and pus (yellow or green fluid) near the nail or under the nearby skin. If the infection is getting worse, you may have a throbbing (pulsating) pain, redness spreading over the toe, or a fever. Antibiotics may be needed to treat infection. It can also help to soak your feet in warm salty water, then carefully dry and rest your feet.

When should I see a doctor?

See a doctor if:

• You have persistent and troublesome symptoms from the ingrowing nail.
• You have symptoms of infection (as above). If you also have diabetes or a poor immune system, see a doctor more urgently, as infections will need treating earlier.
• You have a condition affecting the nerves or sensation (feeling) in your foot. For example, if you have 'diabetic neuropathy' affecting the feet. This is because a loss of sensation 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 podiatrist.

For persistent ingrowing toenails

It may be necessary to remove part of the nail. The usual procedure is as follows:

• The toe is made numb and painless by injecting local anaesthetic into the base of 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. After the operation, the nail will regrow but will be narrower than before.

How can ingrowing toenails be prevented?

• Cut your nails straight across; do not cut them 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 soft.)
• Keep your feet clean and dry. Let air get to your toes when possible.
• Avoid tight shoes and use cotton socks rather than synthetic.