When a toenail is ingrown, the nail is curved downward and grows into the skin, usually at the nail borders (the sides of the nail). This ³digging in² of the nail irritates the skin, often creating pain, redness, swelling, and warmth in the toe. If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odor. However, even if your toe isn't painful, red, swollen, or warm, a nail that curves downward into the skin can progress to an infection.

What Causes Ingrown Toenail?

Ingrown toenails can develop for various reasons. In many people, the tendency to have this common disorder is inherited. In other cases, an ingrown toenail is the result of trauma, such as stubbing your toe, having an object fall on your toe, or engaging in activities that involve repeated pressure on the toes, such as kicking or running.

The most common cause of ingrown toenails is improper trimming. Cutting your nails too short encourages the skin next to the nail to fold over the nail.Another cause of ingrown toenails is wearing shoes that are tight or short.

Certain nail conditions are often associated with ingrown toenails. For example, if you have had a toenail fungal infection or if you have lost a nail through trauma, you are at greater risk for developing an ingrown toenail.

Treatment

Sometimes initial treatment for ingrown toenails can be safely performed at home. However, home treatment is strongly discouraged if you suspect you have an infection, or if you have a medical condition that puts your feet at high risk-for example, diabetes, nerve damage in the foot, or poor circulation.

Home care:
If you don't have an infection or any of the above conditions, you can soak your foot in room-temperature water (add Epsom's salt if you wish), and gently massage the side of the nail fold to help reduce the inflammation.

Avoid attempting ³bathroom surgery.² Repeated cutting of the nail can cause the condition to worsen over time. If your symptoms fail to improve, it's time to see a foot and ankle surgeon.

Physician care:
The foot and ankle surgeon will examine your toe and select the treatment best suited for you. Treatment may include:

Oral antibiotics. If an infection is present, an oral antibiotic may be prescribed.

Surgery. A simple procedure, often performed in the office, is commonly needed to ease the pain and remove the offending nail. Surgery may involve numbing the toe and removing a corner of the nail, a larger portion of the nail, or the entire nail.

Permanent removal. Various techniques may be used to destroy or remove the nail root. This treatment prevents the recurrence of an ingrown toenail.Your surgeon will determine the most appropriate procedure for you.

Following nail surgery, a light bandage will be applied.Most people experience very little pain after surgery and may resume normal activity the next day. If your surgeon has prescribed an oral antibiotic, be sure to take all the medication, even if your symptoms have improved.

Preventing Ingrown Toenails

Many cases of ingrown toenails may be prevented by following these two important tips:

• Trim your nails properly. Cut your toenails in a fairly straight line, and don't cut them too short. You should be able to get your fingernail under the sides and end of the nail.
• Avoid poorly-fitting shoes. Don't wear shoes that are short or tight in the toe box.Also avoid shoes that are loose, because they too cause pressure on the toes, especially when you run or walk briskly.

This information has been prepared by the Consumer Education Committee of the American College of Foot and Ankle Surgeons, a professional society of 5,700 podiatric foot and ankle surgeons.Members of the College are Doctors of Podiatric Medicine who have received additional training through surgical residency programs. The mission of the College is to promote superior care of foot and ankle surgical patients through education, research and the promotion of the highest professional standards. Copyright © 2004,American College of Foot and Ankle Surgeons www.acfas.org

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