Understanding ingrown toenails: why they happen and what to do

An ingrown toenail happens when the edge of your toenail grows down into the surrounding skin. While it often occurs on the big toe, ingrown toenails can affect any toe, causing pain, discomfort, tenderness, redness and swelling around your nail. 

If your ingrown toenail becomes infected you may also notice discharge, such as pus, around your nail. 

What causes ingrown toenails?

Anyone can get an ingrown toenail but lifestyle and genetic factors can increase your risk.

Wearing tight shoes makes it more likely that you’ll develop an ingrown toenail due to the pressure placed on the skin around your nails. Poor technique when cutting your nails also increases your risk, specifically cutting your nails too short and/or rounding the edges. Injury to your toe, such as stubbing it, can also cause an ingrown toenail to develop. 

Medical conditions that reduce blood flow to your feet, such as diabetes, increase your chances of developing ingrown toenails. Your genetics also have a role to play — if you have more curved or fan-shaped toenails, ingrown toenails are more likely. 

Diagnosing ingrown toenails

It is usually straightforward to get a diagnosis of an ingrown toenail. Your doctor will examine your toe, ask about your symptoms, and in rare cases, may recommend an X-ray if they are concerned that your toenail is infected or your bone is involved.  

Treating ingrown toenails

It is important to treat your ingrown toenail to avoid developing an infection or persistent pain. 

In mild cases, this involves soaking your toes in warm water to soften the skin and cutting your toenails using the correct technique, namely cutting your toenails straight across without rounding the edges or trimming them too short. 

Also, make sure you change your socks regularly and wear shoes that fit properly so they don’t place unnecessary pressure on your toes.

In more severe cases, your doctor may recommend removing part or all of the affected toenail. This type of surgery is called a partial or total nail avulsion. 

Surgery for an ingrown toenail

Ingrown toenail surgery (ie a partial or total nail avulsion) is performed under a local anaesthetic injected into your toe — this means you will be awake during your procedure but you won’t feel any pain. A tight rubber band will also be placed around your toe to reduce any bleeding. 

For a partial nail avulsion, the edges of the nail are removed. A total nail avulsion is performed in a similar way except the whole nail is removed — it will slowly regrow over the next 12–18 months. 

In severe cases or cases of recurrent ingrown toenails, the whole nail is permanently removed and a chemical called phenol is applied to prevent the nail from growing down into the skin again and becoming ingrown.

Preventing ingrown toenails

To reduce your risk of developing ingrown toenails make sure you cut your nails properly (ie straight across), wear comfortable shoes with ample room for your toes and keep your feet clean. 

Also, remember to check the health of your toenails regularly, especially if you have diabetes or a condition that reduces the blood flow to your toes. 

Author biography

Mr Mohammed Al-Maiyah is a Consultant Orthopaedic Surgeon at Spire St Anthony's Hospital and Croydon University NHS Hospital, specialising in foot and ankle arthritis, joint replacement and arthrodesis, arthroscopy, sports injuries and trauma, and bunion surgery (correction of hallux valgus). He has completed over 8,000 procedures across different orthopaedic subspecialties, particularly in foot, ankle and trauma surgery.

We hope you've found this article useful, however, it cannot be a substitute for a consultation with a specialist

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