Ingrown Toenail: What It Is and How to Treat It

Ingrown toenails are very common, and in some cases they can lead to complications. Find out why they occur and how they can be treated.
Ingrown Toenail: What It Is and How to Treat It

Last update: 16 December, 2022

An ingrown toenail, also known as onychocryptosis, is often considered a minor medical problem. However, in some cases, it may require surgery, and neglect of the milder episodes can lead to infection. It can occur at all ages, but it’s estimated to be most common between 14 and 25 years of age.

Although it’s difficult to determine its prevalence exactly, some experts estimate that up to 5% of the world’s population suffers from it. The real number may be much higher, because not everyone seeks medical attention when they develop these complications. We’ll analyze its causes, symptoms, and how to treat them.

Causes of an ingrown toenail

As Harvard Health Publishing points out, an ingrown nail is when one corner of the toenail curves downward and digs into the skin. It’s the most common nail-related complication in general and dermatological medicine. Using medical terminology, it happens when the nail grows into the periungual skin and causes inflammation and infection.

The main cause of an ingrown toenail is improper nail clipping. When not trimmed properly, the corner of the nail can press or puncture adjacent tissue. This tissue is softer than other areas, and the nail easily penetrates and starts to grow inwardly. Other factors that can create this condition are the following:

  • Wearing very tight shoes
  • Injuries to the nails or adjacent areas
  • Some medications (such as gefitinib and cetuximab)
  • Foot hyperhidrosis (excessive sweating)
  • Poor foot hygiene
  • Having flat feet
  • Having very curved toenails

Apart from this, trimming the nails in a curved shape or over-trimming them is often the trigger for an ingrown toenail. Doing high-impact activities (such as jogging, climbing and others) is also often among its causes. These criteria aren’t exclusive, and it’s sometimes a combination of them that cause it to occur.

For example, a very sweaty foot (hyperhidrosis) can cause the peripheral nail tissue to soften further; this makes it easier for a poorly trimmed nail to penetrate it when carrying out an activity with certain movements or pressure.

Bone abnormalities can cause it, especially those that increase pressure on the ankles, foot, or toes.

This condition is more common in women. This isn’t because there’s any biological predisposition, but simply that they tend to cut their toenails more frequently. Because of this, there’s is a greater chance of doing it the wrong way.

In the same way, and due to the pressure exerted on the area, both obese men and women tend to develop ingrown toenails.

Ingrown toenail symptoms

An ingrown toenail is painful.
The clinical manifestations of ingrown toenails are quite characteristic.

Ingrown toenails are very easy to spot. They don’t require the mediation of a medical professional, so most patients can tell that the nail is ingrown by looking at the affected area. We leave you with a typical description of what actually occurs during the whole process:

  • Inflamed skin on one or both edges of the toe
  • A reddish or purple coloration in the affected area
  • A collection of fluid between the nail and the skin tissue (pus)
  • Pain when pressing the nail or skin
  • Skin that protrudes or covers part of the nail

If you develop an infection, you’re likely to suffer from certain typical symptoms, which can be a headache, fever, and general malaise. In its initial stages, the skin usually feels harder than other areas, although after a couple of days it becomes more sensitive. You may not feel pain while it inflames and covers part of the nail, and the symptoms aren’t always too intense.

As the American Academy of Orthopedic Surgeons (AAOS) reminds us, the nail that most often suffers from ingrown nails is the big toe (hallux). Swelling and pain can affect wearing shoes, being physically active, and even walking.

It all depends on the severity of the symptoms, as sometimes it can come and go without bothering the patient at all.

Diagnosis of an ingrown toenail

The diagnosis of an ingrown toenail doesn’t require imaging tests or additional evaluations, as it can be made based on simple observation. People can do this by checking the symptoms we’ve described, although sometimes the intervention of an expert is beneficial. This is mainly to rule out some of the following differential diagnoses:

  • The presence of foreign bodies in the skin
  • Onychomycosis
  • Onychomatricoma
  • Eccrine poroma
  • Bunions
  • Injuries to the nail bed
  • Paronychia

Apart from this, it isn’t always necessary to consult a specialist when detecting an ingrown toenail. This is only the case in mild or moderate cases of course. If skin or nail abnormalities should suggest something more serious, or if acute symptoms of infection develop, we recommend you seek medical attention.

How to treat it?

An ingrown toenail being treated.
In severe cases, a procedure is necessary to relieve pressure on the affected area and disinfect the area.

Ingrown toenails should be treated as soon as they’re detected. If this isn’t done, then the nail will continue to grow and embed itself more and more in the skin.

Symptoms will worsen in these settings, and infections may progress to severe episodes. Patients can treat the ingrown toenail themselves at home, although it is recommended that they ask for the services of a pedicurist.

Indeed, to solve the episode it’s necessary to remove the nail embedded in the skin, which often requires trimming it. A foot professional can easily do this, while if you decide to proceed on your own you could make the condition even worse. After carrying out treatment, keep in mind the following:

  • Soak the foot in warm water 2-3 times a day
  • Keep the foot dry for the rest of the day (humidity can soften the skin and encourage nail embedment)
  • Wear comfortable shoes (if possible, opt only for open ones)
  • Take over-the-counter medications to deal with symptoms

Severe cases are treated by surgical intervention. The surgeon may choose to remove all or part of the nail, also because of the underlying nail bed.

The intervention isn’t too complicated, but if you act quickly you can prevent things from getting out of hand. Consult a specialist if you see that symptoms and the visual appearance of the ingrown toenail are of concern.

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  • Bryant A, Knox A. Ingrown toenails: the role of the GP. Aust Fam Physician. 2015 Mar;44(3):102-5.
  • Cho, S. Y., Kim, Y. C., & Choi, J. W. Epidemiology and bone‐related comorbidities of ingrown nail: A nationwide population‐based study. The Journal of dermatology. 2018; 45(12): 1418-1424.

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