Ingrown Toenail Treatment

Author: Chloe Wilson - BSc(Hons) Physiotherapy

Ingrown toenail treatment can usually be carried out effectively at home.  An ingrown toenail is a common cause of toe pain where the edges of the nail push into the surrounding skin causing pain, inflammation and sometimes bleeding.  They usually affect the big toe.  The medical terms for it are an "Onychocryptosis" or "Unguis Incarnatus". 

An ingrown toenail is usually caused by wearing tight shoes, a foot injury, genetics or poor foot care and hygiene. The skin around the edge of the nail becomes inflamed and painful and there may be some bleeding. 

Whilst ingrown toenail treatment is relatively simple, if it is not started quickly, it may become infected and in severe cases, surgery may be required.

Here, we will look at what an unguis incarnatus is, the common causes, symptoms and ingrown toenail treatment options as well as how to prevent them coming back.

An ingrown toenail develops when one or both of the curved side edges of the nail are pushed into the surrounding skin.  As the pressure increases, the nail pierces through the skin causing pain, inflammation, tenderness and redness.  If bacteria enter through the cut in the skin, it may become infected. 

A true onychocryptosis or unguis incarnatus is when the nail has actually cut into the skin, rather than just placing pressure on it. 

There are a number of common causes of an unguis incarnatus:

1)  Poor Nail Cutting:  Cutting your nails too short, or rounding them at the side rather than cutting them straight across results in the surrounding skin starting to fold over the nail.  The nail then grows into that skin

2)  Tight Footwear:  Wearing tight fitting shoes, especially with a narrow toebox or shoes that are too short, exerts more pressure on your toes making them more prone to onychocryptosis

3)  Genetics:  Some people have more naturally curved toenails making them more prone to the problem

4)  Injury: One-off injuries, such as stubbing or dropping something heavy on your foot, or activities placing repetitive pressure on the toe such as repeated kicking or running can often lead to an unguis incarnatus

5)  Nail Infections: Fungal infections can cause thickening of the nail making it easier for it to pierce the skin

6)  Excessive Sweating: this can cause softening of the surrounding skin making it easier for the nail to cut in

Ingrown toenails can affect anyone but are most common in teenagers, as their feet sweat more and in the elderly, as nails get more brittle with age.

In the early stages, an unguis incarnatus will only cause mild irritation.  The toe may feel tender to touch and appear slightly red and swollen.  These symptoms gradually increase as the condition progresses.  The most common symptoms of an unguis incarnatus are:

1)  Pain: Around the toe, especially when pressure is placed on it

2)  Redness: around the edge of the nail

3)  Inflammation:  Swelling in the surrounding areas gradually increases.  Initially there tends to be inflammation of the skin but you may end up with a build-up of fluid around the toe

4)  Pus: if bacteria causes an infected ingrown toenail, there may be yellow or white pus oozing from the area

5)  Bleeding:  In severe cases, the nail may cut through the skin enough to cause bleeding

6)  Excessive Skin Growth:  Extra skin can start to grow over the nail known as hypertrophy

Symptoms tend to get gradually worse so it is important to start ingrown toenail treatment as soon as possible.

Ingrown toenail treatment can usually be carried out at home however, if there are signs of infection or your symptoms fail to settle, you should always consult your doctor.  This is also the case if you suffer from diabetes.

There are two main options with ingrown toenail treatment:

A) Home Remedies

1)  Change Footwear:  wear comfortable shoes that are wide enough not to put pressure through the toes, or when possible go barefoot

2) Nail Correction Tools: There are various ingrown toenail correction tools on the market that work really well to reposition, reshape and file the nail. They are designed for home use and receive excellent reviews making them a popular ingrown toenail treatment tool

3)  Trim Nails: ensure they are cut straight across instead of tapering or rounding the edges, and not cut too short. In some cases, you may need to use specially designed ingrown toenail clippers

4)  Foot Soaks:  Soaking your feet daily in warm water for 15-20 minutes ensures good hygiene and helps reduce pain and inflammation

5)  Massage:  Gently roll away any excess skin away from the top of the nail with a cotton bud.  It can help to use a small amount of olive oil to soften the skin

6)  Painkillers: over the counter painkillers and anti-inflammatory medication can help to reduce the discomfort and swelling.  Always consult your doctor before taking medication

If these ingrown toenail home remedies fail to resolve the problem within a week, you will need to see your doctor or a podiatrist as you may have developed in an infected ingrown toenail.  It may be that you require minor surgery as part of your ingrown toenail treatment. 

B) Surgical Options

There are two types of surgical ingrown toenail treatment commonly performed on an Unguis Incarnatus:

1)  Partial Nail Avulsion: this is where part of the nail is removed, known as a wedge resection.  The area is numbed with local anaesthetic and then one or both edges of the nail are trimmed.  This makes it narrower and gives it a straight edge, making it less likely to pierce the surrounding skin.  Any pus is also drained away.  A chemical such as phenol is used to prevent the nail re-growing.  A wedge resection is a successful ingrown toenail treatment in approximately 98% of cases and takes approximately thirty minutes.

2)  Total Nail Avulsion:  This is where the entire nail is removed. This is also carried out under local anaesthetic and is most commonly performed on people who suffer from repeated problems or failed to respond to other ingrown toenail treatment.

Surgical ingrown toenail treatment to remove all or part of a nail is known as an Onychecotomy.  It is usually carried out at your doctors (or podiatrists) surgery.  The wound will be bandaged and you can go straight home.  You may be given antibiotics to prevent the risk of infection and told to soak the foot to aid healing.  

You may need to rest for 1-2 days keeping your foot elevated and walking to a minimum.  Often there is very little pain but in some instances the foot may feel sore so it is worth talking to your doctor about suitable painkillers.

There are a number of things you can do to reduce the risk of suffering from an onychocryptosis:

1)  Go Barefoot: People who habitually go barefoot don’t get ingrown toenails, so whenever possible, ditch your shoes in favour of going barefoot.  That way, there is no pressure on the nail and therefore no risk of developing onychocryptosis

2)  Wear Comfortable Shoes:  When you are wearing shoes, make sure the fit properly with adequate width and length.  If you work somewhere where there is a high risk of an injury to your foot, it is advisable to wear steel toe boots/shoes

3)  Trim Nails Carefully:  Keep nails short but not too short (no shorter than the surrounding skin), and but straight across rather than rounding them at the sides.  Gentle tapering at the edges is fine

4)  Good Foot Hygiene:  Keep feel clean and dry.  Change socks daily

If this isn't sounding quite like your problem, visit the Toe Pain section.  Alternatively, if you want help working out what is causing your foot pain, visit the foot pain diagnosis section. 

Whilst ingrown toenail treatment can usually be carried out at home, you should always get it checked by a healthcare professional to ensure there are no secondary problems, particularly if you suffer from Diabetes, or else you could make things worse.

Go to Common Causes of Toe Pain or Foot Pain Diagnosis