Definition

Ingrown toenail or onychocryptosis is a condition where the corner or side of the nail grows into the skin. This condition is more common in toenails than fingernails. Of all toenails, it is most common on the big toe. Ingrown toenail can be treated independently, but a doctor can also treat it.

Causes

Ingrown toenail can be caused by:

• Cutting the nail in the wrong direction (e.g. curving the nail by following the shape of the toe, allowing the tip to grow into the skin)
• Irregularly shaped or curly nails
• Wearing footwear that puts a lot of pressure on the big toe, such as socks and stockings that are too tight, or shoes that are too tight, narrow or flat for your feet
• Injury to the nail, because of tripping, putting heavy weight on the foot, or kicking a ball multiple times
• Poor posture
• Poor feet hygiene, e.g. leaving the feet dirty and damp
• Genetic factors

Risk Factor

Ingrown toenail can occur in both men and women. However, the risk could be higher if the individual has feet that sweat a lot, for example if they are teenagers. In addition, elderly are also at risk as the nails get thicker as they age. Not only that, disorders associated with blood vessels or poor blood flow such as diabetes can increase the risk of ingrown toenail.

The use of your feet when exercising can make you susceptible to ingrown toenails. Activities that put pressure on the feet for long periods of time or involve kicking certain objects can also cause nail damage and increase the risk of developing ingrown toenails. Examples of such activities are ballet, soccer, kickboxing, and rugby.

Symptoms

Ingrown toenails are generally painful and get worse over time. Early-stage symptoms of this condition may include:

• The skin around the nail becomes red, swollen, or hard
• Tenderness or pain when the nail is pressed
• Build up of fluid around the nail

If the toenail is infected, symptoms that can be seen include:

• Red and swollen skin
• Pain
• Bleeding
• Pus discharge
• Excessive skin growth around the nail

Diagnosis

The diagnosis of ingrown toenail can be established by your physician based on your complaints and symptoms. Your toenails will also be examined to confirm the diagnosis and determine the appropriate treatment. X-rays may also be done if the toenail appears to be infected. This examination can help the doctor see how far the nail has grown into the skin.

Management

If the ingrown toenail has not been infected yet, you can treat it yourself by doing these:

• Soaking the feet. Soaking your feet in warm water for 15-20 minutes, 3-4 times a day, can reduce swelling and pain.
• Keeping your feet dry. You need to let the skin of your feet "breathe" to avoid sweat or moisture.
• Applying antibiotic cream. You can cover it with a bandage afterward to protect the nail.
• Choosing footwears that can aid in healing the condition. You can choose open-toe shoes or shoes with enough room for your toes. Do not wear high heels.
• Taking painkillers. Over-the-counter painkillers such as paracetamol and ibuprofen can help reduce swelling and pain.

If your symptoms do not improve (or even worsen) within a few weeks, you can pay a visit to a doctor. Your doctor may do the following things:

• Prescribing antibiotics. You may need an antibiotic ointment or medication to treat a bacterial infection of toenail.
• Removing the toenail. If your problem is mild and there’s no pus discharging from the toenail, the doctor may attempt to remove part of the nail and set it in a new position so that it can grow over the skin.
• Removing part of the toenail. The doctor will give you an anesthetic before performing minor surgery to remove part of the nail that has grown into the skin.
• Remove the entire toenail. If you have repeated ingrown toenail in the same nail, your doctor may decide to remove the entire toenail. Your toenail takes about 1 year to grow back to its original size. Also, the risk of recurrence is higher as the nail grows back.

After nail removal, your toe will be bandaged. You will need to elevate your foot for 1-2 days afterward and use special sandals so your toe can heal properly. You are strongly advised to avoid moving your feet too much.

Usually, the bandage will be removed 2 days after surgery. The doctor will also advise you to wear open-toe shoes and soak your feet in salt water until your condition improves. The doctor will also prescribe a course of antibiotics and painkillers to prevent infection and manage the pain.

Complications

If left untreated, ingrown toenail can lead to infection of the finger bones. This infection can also lead to foot ulcers, as well as decreased blood flow to the area. Tissue death and decay may also occur.

Foot infections can be more severe if you have diabetes. Small abrasions and ingrown toenail may be more prone to infection due to decreased blood flow and nerve damage.

If you carry a genetic predisposition that makes you susceptible to developing ingrown toenail, you may experience this condition repeatedly or the condition can affect multiple fingers at once. Your quality of life may suffer due to pain, infection and other foot issues that require multiple surgeries. In such cases, your doctor may recommend removal of the entire nail that is causing prolonged pain.

Prevention

Some things you can do to prevent ingrown toenail are:

• Trimming your nails straight across. Do not cut your nails in a curve, following the front of the finger, as this can make the nail grow into the skin. If you are getting a pedicure, you can ask the person to trim your nails straight across.
• Maintaining a moderate length for the toenails. You should cut your nails parallel to the tips of your toes. If you cut them too short, the pressure of the shoe on your toenails can lead the nail to grow into the skin.
• Wearing shoes that fit properly. Shoes that put too much pressure on the toes or even pinch the toes can cause the nail to grow into the skin. If you have nerve damage to your feet, you may not be able to feel if your shoes are too tight.
• Wear protective footwears. If your activity increases the risk of injuring your fingers, you can use protective footwear, such as shoes with steel toe guards.
• Checking your feet. If you have diabetes, you need to check your feet daily for ingrown toenails or other foot issues.

When to See a Doctor?

You should see your doctor if you have severe pain in the toe that grows inward, coupled with reddish skin around the toenails and spreading pus discharge. You should also visit your doctor if you have ingrown toenails and diabetes. If you have other conditions that cause poor blood flow to the feet (such as peripheral arterial disease), you can also consult your doctor about the treatment of ingrown toenail.

Looking for more information about other diseases? Click here!