Ingrown Toenail: Causes, Symptoms, Treatment, and Prevention

What is an Ingrown Toenail?

An ingrown toenail is a common medical condition where the edge or corner of a toenail grows into the surrounding skin. It most commonly affects the biggest toe, but it can occur in any toenail. Ingrown toenails can cause pain, swelling, redness, and infection. Treatment for an ingrown toenail depends on the severity of the condition. An ingrown toenail is a curable situation but can lead to complications such as abscess formation or the development of various complications if not taken care of properly. 

Ingrown Toenail Symptoms

The Ingrown Toenail Symptoms can vary depending on the severity of the condition. Some common symptoms of an ingrown toenail include:

• Pain and tenderness: The affected area of the toe, usually along the edge or corner of the nail, can be painful and sensitive to the touch. The pain may worsen when pressure is applied, such as when walking or wearing shoes.

• Redness and swelling: The surrounding skin near the ingrown toenail may appear red, inflamed, and swollen. The inflammation is mostly localized to the area around the nail.

• Increased sensitivity: The skin around the ingrown toenail may become more sensitive and may feel sore or throbbing. Even light pressure or contact with socks or shoes can cause discomfort and pain.
• Drainage or pus: In some cases, the ingrown toenail can lead to an infection, which may result in the formation of pus or drainage from the affected area. The drainage may appear yellow or white in color.

• Difficulty in walking or wearing shoes: The pain and discomfort associated with an ingrown toenail can make it difficult to walk or wear shoes, especially if pressure is applied directly to the affected area.

If you suspect you have an ingrown toenail or are experiencing persistent pain or signs of infection, it is advisable to consult a doctor for an accurate diagnosis and appropriate treatment.

What causes ingrown toenails?

Ingrown toenails can be experienced by both men and women. Older people are more prone to the condition as, with age, the toenails get thick. 

Here are some common causes of ingrown toenails:

• Improper nail trimming: Trimming the toenails improperly is a common cause of ingrown toenails. Cutting the nails too short or making the edges round can encourage the nails to grow into the surrounding skin.

• Incorrect nail shape: The natural shape of the toenail can contribute to ingrown toenails. Excessively curved nails have a higher risk of growing into the skin.
• Trauma or injury: Direct trauma or injury to the toe, such as stubbing the toe or dropping something heavy on it, can cause the toenail to grow abnormally and become ingrown.

• Tight or ill-fitting shoes: Wearing shoes that are too tight or narrow can put pressure on the toes and cause the nails to dig into the surrounding skin. This is particularly common when the shoes have a narrow toe box or do not provide enough room for the toes to move comfortably.

• Genetic predisposition: Some individuals may have a genetic predisposition to developing ingrown toenails. Factors such as the shape and structure of the toenails or the way the nails grow can be inherited and increase the likelihood of ingrown toenails.

• Fungal infections: Fungal infections of the toenails, such as onychomycosis, can cause thickening and widening of the nail. This can alter the shape of the nail and contribute to ingrown toenails.

• Excessive sweating: Excessive sweating of the feet, a condition known as hyperhidrosis, can soften the skin around the toenails. This can make the skin more prone to irritation and make it easier for the nails to penetrate the skin.

• Poor foot hygiene: Inadequate foot hygiene can lead to the buildup of dirt, debris, and bacteria around the nails. This can increase the risk of developing ingrown toenails and subsequent infections.

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Types of Ingrown Toenails

Ingrown toenails can be classified into different types based on their severity and presentation. Here are some common types of ingrown toenails observed by the patients:

• Mild ingrown toenail: The nail edge grows into the surrounding skin, causing minimal discomfort. The area may be slightly tender, red, or swollen. Mild ingrown toenails can often be managed with home remedies and proper nail care.

• Acute ingrown toenail: An acute ingrown toenail refers to a more severe and symptomatic presentation. The nail edge penetrates the skin, leading to pain, inflammation, and a higher risk of infection. The affected area may be red, swollen, and tender. Activities such as walking or wearing shoes can be quite painful.

• Chronic ingrown toenail: Chronic ingrown toenails are characterized by recurrent or persistent ingrown nails. The affected area may exhibit signs of inflammation, such as redness and swelling, and can be prone to infections.

• Complicated ingrown toenail: Complicated ingrown toenails occur when the ingrown nail causes complications beyond the typical symptoms. This can include infection, abscess formation, ulceration, or the development of granulation tissue. Complicated ingrown toenails may require medical intervention for proper management.

Ingrown Toenail Diagnosis and Health Screenings

The doctor might suggest several diagnostic tests to get a proper analysis of the foot area before the ingrown toenail treatment. The diagnosis of an ingrown toenail is usually based on a physical examination and a discussion of the symptoms experienced by the individual. In most cases, additional diagnostic tests or health screenings are not necessary to confirm the diagnosis of an ingrown toenail. However, in certain situations where complications or underlying conditions are suspected, the doctor may perform or recommend the following:

• X-ray: X-rays may be used if there is a suspicion of an underlying bone infection (osteomyelitis) or if there is a need to assess the extent of an infection or abscess.

• Blood tests: Blood tests are generally not required for routine cases of ingrown toenails. However, if there are signs of a severe infection or if the individual has underlying health conditions such as diabetes or compromised immune function, blood tests may be performed to evaluate the overall health status and to check for signs of infection or inflammation.
• Physical Examination: This assessment involves doing a comprehensive physical examination of the toe. The doctor also checks for signs of infection or inflammation.
• Skin Test: A skin test is performed to rule out any skin conditions or allergies.

Ingrown Toenail Treatment

If you already have an ingrown toenail, there are several treatment options available, including surgical and non-surgical. The appropriate treatment will depend on the severity of the ingrown toenail and whether or not it has become infected. Firstly, the doctor suggests some conservative methods to the patient, but if the situation persists or even gets worse, then surgical intervention is performed.

Here are some of the common ingrown toenail treatment options available for patients:

Surgical:

• Partial Nail Avulsion: Partial nail avulsion is the most commonly used technique for performing ingrown toenail removal. This technique includes eliminating the edge or corner of the toenail that is digging into the skin and the nail bed underneath it. The remaining part of the nail is left unharmed.
• Total Nail Avulsion: The total nail avulsion technique includes removing the entire toenail, including the nail bed below it. It is usually reserved for severe cases of ingrown toenails or cases where the condition is recurrent. 
• Chemical Matricectomy: In the chemical matricectomy technique, a chemical, mostly phenol, is used to destroy the nail matrix (the tissue that produces the nail) in the affected area. Phenol is a caustic agent that destroys the matrix cells and prevents the nail from growing back to the exact location. 
• Laser Surgery: Laser surgery can remove the ingrown toenail and cauterize the tissue to prevent regrowth. The laser energy destroys the tissue and seals blood vessels, reducing bleeding and post-operative pain. This technique is not commonly used and is mostly reserved for more severe cases. 
• Radiofrequency Ablation: The radiofrequency ablation technique uses a special device that delivers a high-frequency electrical current to the affected area, which destroys the tissue and prevents the ingrown toenail from growing back. 

Non-surgical:

• Soaking the foot: Soaking your foot in warm water can help reduce pain and swelling associated with an ingrown toenail. Add Epsom salt or a mild antiseptic solution to the water for added benefits. Soak your foot for about 15-20 minutes a few times a day.

• Proper nail care: Gently lift the ingrown edge of the nail using a clean cotton ball or dental floss. This can help relieve the pressure on the affected area and allow the nail to grow properly. However, be cautious not to force or cut the nail too aggressively, as this can worsen the condition.

• Antibiotics: If the ingrown toenail is infected, the doctor may prescribe antibiotics to help clear the infection. Follow their instructions and complete the full course of antibiotics, even if the symptoms improve.
• Over-the-counter pain relievers: Non-prescription pain medications, such as acetaminophen or ibuprofen, can help alleviate pain and reduce inflammation associated with an ingrown toenail. Follow the recommended dosage instructions.

What happens if the ingrown toenail is not removed?

Ingrown toenail is a curable medical condition and should be taken care within proper time. If left untreated, it can get worse and cause various complications, including: 

• Infection: There might be some chances of infection in the skin near the ingrown toenail, which may lead to pain, redness, discomfort, and swelling. This infection can further spread to various parts of the foot and would result in a serious condition called cellulitis.

• Chronic Pain: The patient suffering from ingrown toenails experiences extreme pain and discomfort, making it difficult to walk and wear shoes. 

• Nail Deformity: In some rare cases, chronic ingrown toenails generally cause the nails to grow abnormally, and sometimes they might fall off, resulting in permanent nail deformity.
• Worsening of symptoms: People with medical conditions like diabetes or peripheral artery disease are mostly more prone to the risk of complications from ingrown toenails, such as foot ulcers or gangrene. 

It is very important to get proper medical attention from the healthcare team at the earliest after observing the symptoms of an ingrown toenail to avoid any kind of possible complications.

How to prevent ingrown toenails?

Ingrown toenails can be quite painful and uncomfortable, but there are several steps you can take to help prevent them. 

• Trim your toenails properly: Cut your nails straight across without rounding the corners. Avoid cutting them too short, as this can increase the likelihood of ingrown toenails.

• Wear comfortable shoes: Choose footwear that provides enough room for your toes to move freely. Tight-fitting shoes can put pressure on your toenails and increase the risk of ingrown toenails.

• Practice good foot hygiene: Keep your feet clean and dry to prevent infections that can lead to ingrown toenails. Wash your feet regularly, especially after physical activity, and make sure to dry them thoroughly, paying attention to the areas between your toes.

• Avoid trauma or injury to the toes: Protect your toes from injury by wearing appropriate footwear during physical activities or work that may put your feet at risk. Accidental trauma to the toenails can cause them to grow abnormally and become ingrown.

• Maintain a healthy weight: Excess weight can put additional pressure on your feet and toes, increasing the risk of ingrown toenails. Maintaining a healthy weight can reduce this risk. 
• Be cautious with pedicures: If you get professional pedicures, ensure that the tools used are properly sterilized to prevent infections. Also, avoid having your cuticles cut, as this can increase the risk of ingrown toenails.