Definition

An ingrown nail is a condition where the corner of the nail grows into the skin of the finger. This condition is common and usually occurs on the big toe, although it can occur on any finger.

Causes

Causes of ingrown nails include:

• Wearing socks or shoes that are too narrow presses the nail toward the finger
• Cutting the fingernail too short or unevenly
• A heavy object striking the nail, tripping, or repeatedly kicking a ball could all result in injury
• Nail infection
• Certain medical conditions
• Poor standing posture

Risk Factors

Some factors that could increase the risks of ingrown nails in individuals are:

• In the teenage years, when feet tend to sweat more, it could soften the nails and skin. However, older people are also at a higher risk of ingrown nails as the nails thicken with aging
• Have nail care habits that cause the nail to grow into the skin, for example, cutting the nail too short or curving the corner of the nails
• Having reduced ability to care for the nails
• Wearing socks or shoes that are too narrow
• Engaging in activities that pose a risk of injuring the fingers, such as running and kicking
• Ballet, soccer, kickboxing, and football athletes are at high risk.
• Having several medical conditions, such as diabetes, that could cause disruption of blood flow

Symptoms

Ingrown nails will cause symptoms such as:

• Pain of the affected finger
• Skin of the affected finger are inflamed and characterized by redness and swelling
• Sometimes infection could arise, characterized by discharge of pus or fluid from the wound. You may also experience fever and chills if there is an infection.

Diagnosis

Your doctor can diagnose ingrown nails by asking you about your symptoms and examining your nails and fingers.

Management

You can treat ingrown nails yourself, especially for mild and not severe conditions, with no complications. The ways to treat them at home are:

• Soak the feet in warm, soapy water for 10–20 minutes, 3–4 times a day, until the symptoms subside. This could soften the skin of the affected finger and reduce the risk of infection. Other than the times when you’re soaking your feet, keep your feet dry.
• Put cotton wool or dental floss under the nail. After soaking your feet, tuck in a clean cotton swab or dental floss under your nail. This will help the nail grow over the skin edge
• Apply moisturizer or petroleum jelly (Vaseline) to the affected area
• Choose comfortable footwear, preferably open-toe shoes, until the symptoms subside.
• Do not pick at your nail
• Take over-the-counter pain medications such as paracetamol and ibuprofen to help minimize the pain

However, if the pain is severe or the area of your inflamed skin increases, then you can consult a doctor to reduce the pain and prevent complications. The doctor could recommend therapies such as:

• Lifting the nails. For mildly ingrown nails, the doctor may lift the ingrown nail and place cotton or dental floss underneath it to separate the nail from the overlying skin and help the nail grow over the fingertip, usually within 2–12 weeks. Once at home, you will need to soak your feet and change the cotton every day. There are cotton pads coated with solution that makes them waterproof (colodion) so you don't need to change them every day.
• Taping the nail. This method involves pulling the skin away from the ingrown nail using tape.
• Inserting a device (gutter splint) under the nail. The doctor will numb the finger and insert a small device under the nail. The device will stay there until the nail has grown beyond the tip of the finger. This method can also reduce the pain caused by ingrown nails.
• Removing part of the nail. For more severe ingrown nails (usually accompanied by inflammation, pain, and pus discharge), the doctor may trim or remove the problematic part of the nail. Before this procedure, the doctor will inject anesthetic medicine into your finger. The time it takes for the nail to grow back is 2 to 4 months.
• Removing the nail and surrounding tissue. If this condition has occurred repeatedly on the same finger, the doctor may recommend removing part of the nail and the underlying tissue at once. This procedure can prevent the nail from growing back.

After the nail removal procedure, you can take painkiller medicines if needed. Applying wet compresses for a few minutes or for a few days until the swelling goes down may also be helpful. You could also elevate your feet or hands while resting for up to 12–24 hours after the procedure. Avoid activities that may injure your fingers; avoid swimming or bathing until your doctor has given permission. However, you may shower the day after the procedure.

If there is an infection, the doctor will administer antibiotics.

Sometimes, even if the procedure is successful, the ingrown nail may recur. However, surgical removal of the nail is better at preventing the recurrence of ingrown nails than non-surgical methods.

Complications

If you have diabetes or other medical conditions that could cause blood flow disruption and nerve damage to your feet, then you are more susceptible to developing complications from ingrown nails. Minor foot injuries such as cuts, scrapes, fish eyes, or calluses can be difficult to heal completely and are prone to infection.

Prevention

To help prevent the onset of ingrown nails, you could do the following:

• Trim your nails straight across. Do not cut your nails in a curve to follow the front of the finger. If you are getting a pedicure, you could ask the person to trim your nails straight across. If you have a medical condition such as diabetes and are unable to cut your nails, then you can go to a podiatrist to get your nails trimmed regularly
• Maintaining the nail length from being too short. Cut the nail to the limit of the fingertip. If you trim them too short, the pressure from the shoe or gloves on the fingers will cause the nail to grow into the finger
• Wear comfortable shoes that are not too tight. Shoes that put too much pressure on the nails can cause them to grow into the surrounding tissue. If you have nerve damage in your feet, you may not be able to feel if your shoes are too tight
• Wearing protective footwears. If you are doing activities that pose a risk of injuring your feet, you could wear specialized protective footwears
• Keep your feet clean and dry
• Checking the condition of your feet. If you have diabetes, you need to check daily for ingrown nails or other foot diseases.

When to See a Doctor?

You could consult a doctor if:

• You have tried treating the ingrown nail at home but your condition did not improve
• The finger is very painful and swollen with pus discharge
• The inflammation of the skin appears to be increasing
• You feel feverish or shivering
• You have diabetes or other medical conditions that may interfere with the wound healing process
• If you have undergone a nail removal procedure but it does not heal, then you should go back to consult your doctor

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