Ingrown toenails

What is an Ingrown toenail?

An ingrown toenail occurs when the side of the nail pierces the skin (nail fold) causing it to become inflamed, painful and swollen. The big toe is most commonly affected.

What causes Ingrown toenails?

  • A small spike of nail left behind after poor nail cutting is enough to cause an ingrown toenail
  • Nail 'picking'
  • Damage to the nail following trauma
  • Poor tight fitting footwear can cause the sides of the nail to push into the skin, particularly if the nails are curved or 'involuted'
  • Children and adolescents are more prone to ingrown toenails
  • Sporty and active people are also more prone to ingrown toenails

What are the signs and symptoms of an Ingrown toenail?

When a piece of nail pierces the skin to create an ingrown toenail, an inflammatory response occurs. It is common to experience one or more of the following signs and symptoms -
  • The area of skin around the side of the nail (the nail fold) becomes red and swollen
  • The piercing of the nail into the skin can be very painful and tender to touch. Finding footwear to accommodate a painful, swollen toe can be difficult and even light pressure from bedclothes can be uncomfortable
  • When the nail pierces the skin it creates an opportunity for bacteria to enter the site creating a localised infection. It is likely weep, discharge pus and bleed. It may have an unpleasant smell
  • If left untreated, the nail will grow deeper into the nail fold and become even more painful. The inflammation will increase and the infection can spread throughout the foot and the body

Treatment of Ingrown toenails

If you suspect you have an ingrown toenail, do not try to remove it yourself. Digging and cutting down the sides of the nail can be painful and can make the ingrown toenail worse. A podiatrist can treat the ingrown toenail safely (see below).

Antibiotics may be prescribed to treat localised infection.

Your podiatrist or GP can advise on the most suitable treatment for you.

What can a Podiatrist do?

  • Safe removal of the nail spike and smoothing of the nail edge to prevent recurrence
  • A nail 'pack' of cotton wool or gauze may be inserted between the nail edge and the skin to prevent the nail from digging into or piercing the skin
  • If the ingrown toenail is very painful to touch, the podiatrist may offer an injection of local anaesthetic before removing the ingrown toenail
  • Advise on correct nail cutting technique and preventative measures to avoid recurrence
  • In some cases, it may be necessary to permanently remove a section of the nail following an injection of local anaesthetic. A chemical is used to destroy cells in the area of the nail bed where the ingrown nail section grows from. Following the procedure, it is necessary to keep the toe dressed, clean and dry for approximately 6-8 weeks depending on the individual rate of healing. This procedure is very successful for treating recurring or chronic ingrown toenails
  • Some podiatrists can prescribe antibiotics to treat localised infections

Prevention of Ingrown toenails

  • Cut your nails properly - follow the natural curve of the end of the nail, leaving a 'free edge' of nail at the tip of approximately 2-3 mm (0.25 inch)
  • Do not cut or dig into the sides of the nail
  • Use proper nail clippers or nail scissors
  • If you have difficulty reaching or seeing your toenails, ask somebody else to cut them for you, or try filing them with an emery board. Alternatively see a podiatrist
  • Choose footwear that is wide and deep enough around the toe area to accommodate your toes comfortably

When should I seek medical care?

If you suspect you have an ingrown toenail, you should consult a podiatrist in the first instance. If the toe is infected, see your GP for antibiotics as soon as possible. If you notice that the redness is spreading, visit your GP or A&E immediately. This is a sign of spreading infection and can be very harmful.