TOENAIL, INGROWN

 Basic information

description

An ingrown toenail is a common problem in which one or both edges of a nail grows into the flesh of a toe. It usually occurs in the great (big) toe. This can lead to infection and inflammation.

FREQUENT SIGNS & SYMPTOMS

Pain, tenderness, redness, swelling, and heat in the toe where the sharp nail-edge pierces the nearby fold of tissue. Once tissue around the nail becomes red and sore, infection often develops.

causes

• An ingrown toenail is likely to occur with one of the following conditions:
  • The nail is more curved than normal.
  • The toenail is clipped back too far, allowing tissue to grow up over it.
  • Shoes fit poorly, forcing the toe of the shoe against the nail and surrounding tissue.
  • Injury to the nail, or infection of the nail.
  • Sports activities that require sudden stops ("toe jamming").

risk increases with

• Any of the causes listed.
• Poor blood circulation to feet (such as with diabetes).

PREVENTIVE MEASURES

• Wear roomy, well-fitting shoes and socks.
• Carefully cut toenails straight across, and not too short.
• People with diabetes or blood vessel disease have poor healing abilities. Be very careful in trimming your toenails. Foot injury is a risk with these disorders because of changes in blood flow to the feet.
• If you often handle heavy objects in your work, consider wearing work shoes with steel toe boxes.
• Keep feet clean and dry.

expected outcomes

Curable with treatment.

possible complications

An ingrown toenail may become very painful, red, and swollen with pus if treatment for infection is delayed too long. Sometimes a bloody growth called proud flesh builds up on the side of the nail.

 diagnosis & treatment

general measures

• The following home treatment may help mild cases:
  • Soak toe for 20 minutes twice a day in a gallon of warm water (may add 2 tablespoons of Epsom salts).
  • Lift the nail corners gently, and wedge a very small piece of cotton under the ingrown nail edges. This will lift the nail slightly so it can grow past the skin tissue it is digging into. Replace the cotton daily. Do not cut a "V" in the middle of the nail. This is not helpful.
  • There are certain products you can buy that may soften the nail and the skin around it, which can help relieve the pain. Follow the directions carefully. These products should not be used if you have diabetes or a blood vessel problem.
• See your health care provider if home care does not help. Your foot and toe will be examined. If there is an infection, drugs usually relieve symptoms within 1 week. If an ingrown toenail occurs often, then surgery is usually the best treatment.
• The type of surgery will depend on how severe the problem is. It may involve just removing overgrown skin tissue, removing a portion of the toenail, or complete removal of the toenail.

medications

• Antibiotic ointment may be prescribed for infection.
• You may use ibuprofen or acetaminophen for pain.
• A tetanus shot or booster may be recommended.

activity

• Resume your normal activities as soon as symptoms improve. You may need to wear sandals or a shoe with the toe cut out until the toe heals.
• If you have surgery, your health care provider will instruct you about aftercare, such as keeping the foot propped up as much as possible.

diet

No special diet.

 notify our office if

• You have symptoms of an ingrown toenail that persist despite self-treatment.
• The following occur during treatment or after surgery:
  • Fever.
  • Increased pain.
  • Signs of infection (pain, redness, heat, swelling, or tenderness) in the toe.
  • Red streaks going up the foot or ankle.

Special Notes: