Synonyms and Keywords
Ingrown nail, ingrown toenail; nail infection, toe infection; embedded nail, embedded toenail; onychocryptosis, unguis incarnatus, acronyx.
What is an ingrown nail?
Ingrown nail is a painful condition that can affect the nails of the hand or feet, but occurs most often with the toenails.
A toenail that is “ingrown” curves and digs into the skin at the sides of the nail, usually creating pain, redness, swelling, and heat, and often becoming infected. Interestingly, however, even when there is no pain, swelling, redness or heat, a nail that curves down into the skin can still progress into a serious infection.
What causes an ingrown nail?
Well, that depends on whose nail we’re talking about. Heredity can be a culprit — many people inherit the tendency for ingrown toenails. Other folks have nails that are just too large for the toe. And as far as toes are concerned, if yours is chubby or fleshy, it can be more likely to have a nail grow into it. Similarly, if your feet swell a lot, you can be more prone to having an ingrown toenail.
Other cases may result from an injury, such as something heavy falling on your toe — mom, watch those big tomato soup cans — or from just stubbing your toe, or going through the end of the shoes as sometimes happens during sports or other strenuous activities (have you seen some teenagers’ sneakers?). Certain repeated physical activities, such as kicking or running, can also put pressure on the toes, creating an injury by causing the nail to press into the flesh. Picking or tearing at the corners of the nails, or pressure from the toe next to the nail, can also be a factor.
Most people’s ingrown nails result from improper trimming and cutting. Cutting the nail too short causes the skin next to the nail to fold over. Rounding off the tip or curving the nail can cause the nail edges to turn in. You may not even be doing this on purpose. As our eyesight begins to fail, or if we have trouble reaching our toes easily, or if our nails become too thick, it can be difficult to trim nails correctly.
Other physical conditions such as fungal or bacterial infections, lung disease, advancing age, poor circulation, bone spurs, and certain drugs can create nail abnormalities that cause the nail to curve.
Shoes that are too tight or press on the toenail — even tight socks and panty hose — often create a problem, especially if your nails tend to curve. Ladies, how about those sleek high heel pumps with pointed toes, and your daughter’s cute flat little flats that smash from the top? Shoes that are pointed, too narrow, too short, or too shallow in the toe box (front) part of the shoe result in bunching of the toes and cause the nail to curl and dig into the skin.
Who gets ingrown nails?
About 5% of people in the United States develop ingrown nails at some point in their lives. These people are almost always adults. Ingrown nails are uncommon in children and infants, and more common in men that in women.
Young adults in their 20s and 30s are most at risk, but it is important to note that young people who wear ill-fitting shoes as their feet are growing and developing are also increasing their chances of ingrown nails.
What are the symptoms of an ingrown nail?
Pain is the most common symptom of an ingrown nail. When it’s at its worst, you can be sure that those little piggies won’t be going to market, or anywhere else. Ingrown nail pain ranges from mild sensitivity to excruciating scream-your-head-off kind of pain — especially if you bump the affected toe, and the nail digs further into the flesh. The pain worsens with pressure, such as wearing tight shoes or even just the weight of a bed sheet.
Other common symptoms are redness and swelling at the corner of the nail and at the end of the toe. The area may feel warm to the touch. Later, as the nail continues to dig in and irritate, extra skin and tissue will grow around the sharp point and you may get a yellowish drainage as well, or a watery discharge stained with blood. So even if you have no pain, if you have one of the three threats — swelling, redness, or heat — it’s time to act to head off infection.
If the area becomes infected — which it often does — the swelling will get worse, with white or yellow pus collecting and draining from the area. Red skin may surround a lighter-colored area. In a few cases you may even develop a fever.
How do you diagnose an ingrown nail?
The doctor will assess your ingrown nail by asking you how it happened, and when it began — for example, if you were injured, what exactly happened to you (not a bowling ball!) and when it took place (when was your son’s birthday party?). He will also ask about any other medical problems you have, what medications you take, and the date of your last tetanus immunization. He will decide whether or not there is an infection present.
Besides examining your nail and foot in detail, the doctor may also check your temperature, pulse, blood pressure, lymph nodes in the groin, and in certain cases might also take an X-ray. If you have a severe infection, he may also perform blood tests, particularly if you are diabetic.
How do you treat an ingrown nail?
After the examination, your doctor will choose the treatment that is best for your particular situation. If there is no infection, he will give you instructions for treatment such as elevating the foot, warm soaks, proper shoes, and frequent cleaning.
The doctor may choose to use a splint — such as a cotton wick, plastic strip, or plastic tube — to protect your skin from that nasty sharp corner of the invading nail. Occasionally, he may try to file or cut the nail down the center in order to change the shape of the nail as it grows. To speed up the healing — since we want to get well and train for that marathon or shopping spree as fast as possible — he may also apply local anesthetic and remove the extra tissue that has grown around the inflamed area, just to get things moving a bit faster.
If necessary, a number of different minor surgical procedures can be used to ease the pain and remove the problem, almost all of which are done in the office under a local anesthetic. If the infection is extremely severe or if your physical condition or medical history warrants it, the doctor may choose to do the procedure in the hospital instead. He may also give you a tetanus immunization.
For the procedure, the doctor will apply a local anesthetic to numb the area, so you won’t feel a thing. He will then drain the infection and remove the extra tissue that has grown around the end of the nail. Next, he will cut along the edge of the nail where the skin is growing over, removing that portion of the nail so that the skin or infection can heal without the nail pushing on it. This procedure is called “partial nail avulsion.”
Sometimes a chemical may be applied to the skin under the nail, or the doctor may use lasers or extreme cold on the cells in the nail bed. This is done to keep the edge of the nail that caused the problem from growing back, because we’d all rather not have to go through this again. For annoying persistent infections that insist on returning to bother us over and over, the nail root may have to be removed. A specialist may perform a procedure called a “lateral matriectomy” which removes a portion of the nail bed.
After surgery, the doctor will apply a bandage and give you instructions about what to do. You will need to keep your foot elevated for a few hours, and rest is recommended. Most people experience very little pain after surgery and you may go back to school or work or your normal activity the next day, but you will have to wait at least two weeks before you can start running or kickboxing or engaging in similar strenuous physical activities.
Your surgeon may prescribe antibiotic medication, and you will have to take all of it even if you have no symptoms. Wearing open toed shoes to avoid pressure on the area will help you to heal faster. It will take two to four months for the nail to grow out again.
Self-care at home
There are several simple and inexpensive home remedies you can take a stab at to relieve that stabbing in your toe, as long as your condition is not severe or while you are waiting to consult your podiatrist:
- Soak the foot in warm water four times a day. You may add ½ cup of Epsom salts, which contain magnesium sulfate, a substance that reduces swelling and has antibacterial properties. This soak can provide soothing relief.
- Cut a lemon in half. Put your toe in the lemon, and place a sock over your foot. Let this soak overnight. Lemon has antibacterial and antiviral properties.
- For brittle nails, you can apply lip-moisturizing oil on your nails every night before bed, to make nails thinner and softer and easier to trim with clippers.
- You can apply Orajel or any topical tooth pain reliever to numb the pain. However, remember that medications may help with the pain, but do not treat the problem.
- Place a piece of fresh onion or a clove of garlic on the nail and bandage; leave on overnight. Onion and garlic have antimicrobial and antifungal properties.
- Put your foot in a warm tub of salty water for ten to 15 minutes before cutting the nail.
- Apply propolis tincture — bee harvested tree resin — which is thought to have antifungal and antibacterial properties that help heal wounds. However, people who are allergic to pollen should not use propolis tincture, since there is a small amount of bee pollen present in it that might cause an allergic reaction.
- Wash the affected area twice a day with soap and water. Keep it clean and dry at all times.
- Wear sandals — no high heels or tight fitting shoes.
- Over-the-counter antiseptics, such as peroxide or iodine, can be used to help minor infections.
- Apply tea tree oil and lavender, which have antiseptic properties.
- Soak the affected toe with five drops of calendula tincture diluted in 1 / 2 cup hot water for 15-30 minutes, then wrap the toe in linen cloth. Calendula is antiviral, anti-inflammatory and fights bacteria.
Never use a needle to pierce the swelling. Doing this can cause an infection or worsen one if you already have it.
How do you prevent an ingrown nail?
The first step toward healthy, pain-free stepping is to trim your nails properly. First soften them in warm water, then cut them straight across — but not so perfectly straight that they have sharp square corners that snag and feel uncomfortable. Do not cut your nails so short that you can’t get your fingernail under the sides and end of the nail. The most important thing to avoid is cutting the nail shorter than the flesh around it.
Don’t pay attention to the old wives’ tale about cutting a V-shaped wedge out of the center of the nail so the sides will grow toward the center and away from the edge. Nails have no regard for your intentions — they grow from back to front, even if you get whimsical and cut them with pinking shears (don’t even consider this).
The second step in prevention is to wear shoes that fit well, without pressing the top or the tip of your toe and nail. Make sure that your shoes are not so narrow that they force your toes to bunch up inside like sardines in a can, and check to see that there is no friction on your skin. Sandals are great to wear, but if you have an injured or infected toe, do not wear them in places that are covered with bacteria — such as city streets — or on uneven ground that increases your chances of bumps and cuts.
Believe it or not, the color of your socks can make a difference. If you have a wound or infection, colored socks have dyes that might leak into the injury and irritate it further. Wear white socks only, especially if you are allergic or sensitive to dyes. And for those of you who love pedicures, watch out — the tools that touch your feet should be sterilized before they come near you.
People with diabetes need routine foot exams and nail care. Diabetics are particularly at risk for ingrown nail infection, for two important reasons. First, their weakened immune systems make them more prone to contracting infections in general. Secondly, diabetics can develop nerve disorders that cause loss of sensation in the feet, so they may not suffer the painful warning signs that send most people running — or rather, limping — to the doctor.
For these reasons, people with diabetes — or anyone with numbness in the limbs — should be on the lookout for any redness around the toenails, and report it to their doctor immediately. Infected ingrown nails can develop into serious medical problems, including gangrene that can result in risk of losing a limb. Diabetics with thickened toenails should see a podiatrist to have their nails trimmed under antiseptic conditions.
Finally, although we do not yet have any specific diet against ingrown nails, eating healthful and nutritious meals that emphasize green leafy vegetables and fruits rich in folic acid can greatly assist and speed up the healing process.