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Ingrown toenail: Treatment, symptoms, advice and help

About ingrown toenail

Ingrown toenail (Onychocryptosis or Unguis incarnatus) is a common form of nail disease in which the nail grows inwards so that it cuts into one or both sides of the nail bed.

Ingrown toenail: Incidence, age and sex

Ingrown toenail is a very common condition which may affect an individual at any age. There seems to be no gender predilection.

Signs and symptoms of ingrown toenail: Diagnosis

Symptoms include pain along the margin of the nail which is aggravated by wearing tight footwear. The nail is sensitive to mild pressure. Bumping of the affected toe produces sharp pain. Signs include redness and swelling of the area around the nail and drainage of pus and blood tinged watery discharge.

The diagnosis of the condition can be clearly established on physical examination and require no further tests or investigations.

Causes and prevention of ingrown toenail

Wearing tight shoes (with narrow toe box) and tight socks, foot exposure to prolonged moisture, improper nail care, fungal infection of toes, acute injury or repetitive trauma to the nail and genetic susceptibility are the common causes. Preventive measures include careful clipping of toenails i.e. the nails should be cut straight across, wearing well-fitting shoes and keeping the feet clean and dry.

Ingrown Toenail: Complications

Ingrown toe nail can lead to infection of the nail bed or nail fold (paronychia). The nail too may develop fungal infection. Trauma or injury to the affected toe can cause collection of blood under nail bed (haematoma).

Ingrown Toenail: Treatment

The treatment of ingrown toenail includes both conservative and surgical modalities. Conservative treatment can be tried in mild cases and includes the following measures. Socks must be changed at least once in a day and removed at night. Shoes should be well-fitting. They should be kept dry and treated with antibacterial shoe product. Wash the foot, including the affected area, twice a day with soap and water. Keep the feet clean and dry during the rest of the day. Soaking the affected toe in an antibacterial solution for 30 minutes daily for few days can clear the infection allowing the toe to heal. Diabetics and patients with poor circulation should seek podiatric consultation for ingrown toenail without delay.

Surgical modality includes a procedure called ‘wedge resection’ in which the affected digit is treated under local anaesthesia. The nail along with the edge that is growing into the skin is ablated and the offending piece of the nail is pulled out. The entire procedure takes 30 to 45 minutes and the wound usually heals by granulation in 2 weeks to 2 months. Oral or topical antibiotics and special soaks are to be used for a week after surgery. In some cases, complete removal of the whole nail is done. If there is recurrence in spite of complete removal, the nail matrix is coated with phenol so that none of the nail will grow back. This is known as permanent or full nail avulsion.