The HSE have produced an excellent summary of ingrown toenail management, which we have reproduced here. One of the treatments discussed below, 'partial nail avulsion', is the treatment we offer here in this clinic.
An ingrown toenail occurs when the sides of the toenail grow into the surrounding skin. The toenail curls and pierces the skin, which becomes red, swollen and tender.
The big toe is most likely to be affected, either on one or on both sides.
Who is affected by ingrown toenails?
Ingrown toenails affect both men and women. They tend to be more common among teenagers and older people.
During the teenage years, the feet tend to sweat more. As a result, the toenail and surrounding skin can soften and split, resulting in an ingrown toenail.
Older people also sometimes get ingrown toenails because the nails naturally get thicker as a person ages. This can make the nails more difficult to cut and more likely to put pressure on the skin surrounding the nail.
Badly cut toenails and tight fitting shoes are two possible causes of ingrown toenails.
The type of treatment that is recommended will depend on the severity of the ingrown toenail. In most cases, an ingrown toenail can be successfully treated by either removing a section of the affected toenail or by removing the entire nail.
To prevent an ingrown toenail from getting worse, there are several self-care measures you can take.
Left untreated, an ingrown toenail can cause the toe to become infected. It may also cause an abscess (a painful, pus-filled swelling) to develop that will require surgery.
Symptoms of an Ingrown Toenail
The symptoms of an ingrown toenail vary according to how severe it is.
Mild symptoms may include:
inflammation (swelling) of the skin at the end of the toe
pain if pressure is placed on the toe
red skin in the affected area
a build-up of fluid in the area surrounding the toe (oedema)
Moderate symptoms may include:
increased inflammation (swelling) of the toe
white or yellow coloured pus coming from the affected area
the toe becoming infected
Severe symptoms may include:
increased pain, redness and inflammation (swelling)
an overgrowth of skin around the affected toe (hypertrophy)
Visit your GP or a podiatrist (foot care specialist) for advice if you have any of the symptoms of an ingrown toenail.
Causes of an Ingrown Toenail
An ingrown toenail can have a number of different causes, including:
Incorrectly cut toenails
Having badly cut toenails increases your risk of developing an ingrown toenail. Cutting your toenails too short, or cutting the edges, will encourage the surrounding skin to fold over your nail and the nail to re-grow into the skin.
Tight-fitting shoes, socks or tights
Wearing tight-fitting footwear places pressure on the skin around your toenail. If the skin is pressed onto the toenail, it is likely to be pierced. It can also cause your toenail to curve inwards towards your skin, resulting in an ingrown toenail.
Excessive sweating or poor foot hygiene
The skin on your foot can become moist and soft through excessive sweating or from poor foot hygiene, such as not changing your socks regularly. If the skin around your toenails is soft, it is easier for your toenail to pierce the skin and embed itself within it.
Injuring your toenail can sometimes cause an ingrown toenail to develop. For example, damage can occur if you stub your toe or if the nail is accidentally ripped off.
Sometimes, a toenail can become thicker and wider if it has been affected by a fungal nail infection, such as athlete's foot. If the toenail becomes brittle, pieces can break off easily, making it easier for the nail to pierce the surrounding skin and for an ingrown toenail to develop.
Natural shape of your toenail
If you have naturally curved, or fan-shaped, toenails, your risk of developing an ingrown toenail is increased. This is because the sides of your nail are more likely to press into the nail fold (the skin surrounding the nail).
Diagnosing an Ingrown Toenail
If you have an ingrown toenail, there are a number of self-care measures that can be taken to prevent it getting worse.
When to visit your GP
If you've tried the self-care approach and your ingrown toenail persists, visit your GP or podiatrist for advice. Podiatrists are healthcare professionals who diagnose and treat foot conditions.
Your GP or podiatrist will be able to diagnose an ingrown toenail by examining the affected toe and the skin around your nail. They will also ask whether you have taken any measures to treat the nail yourself, such as trimming your toenails to try to prevent the ingrown toenail developing further.
If you have diabetes, it could affect the healing of your toenail. Diabetes, particularly if it is poorly controlled, can cause the nerves in your legs and feet to become damaged. This is known as neuropathy and it can sometimes lead to a number of foot-related problems.
Treating an Ingrown Toenail
The recommended treatment for an ingrown toenail will depend on how severely the nail is affected. Treatment includes self-care measures and nail surgery.
If your ingrown toenail is in the early stages and is only mildly inflamed, there are several things you can do to prevent it getting any worse. These are described below.
Practise good foot hygiene by taking care of your feet and regularly washing them, using soap and water.
Trim the nail straight across to help prevent pieces of nail continuing to dig into the surrounding skin.
Gently push the skin away from the nail using a cotton bud (this may be easier after using a small amount of olive oil to soften the skin).
Wear comfortable shoes that are not too tight and provide space around your toes.
Painkillers, such as paracetamol, can be used to help relieve any pain (children under the age of 16 should not take aspirin).
If your toenail does not improve, your GP or podiatrist may recommend that part, or all, of it is surgically removed.
Partial nail avulsion
Partial nail avulsion, where part of the toenail is removed, is the most common surgical procedure for treating ingrown toenails. It is about 98% effective.
Partial nail avulsion is carried out under local anaesthetic (painkilling medication), which is injected into the base of your toe. The edges of your toenail are cut away to make the toenail narrower and give your nail a straight edge. This makes it less likely to dig into the surrounding skin.
After the edges of the toenail have been cut, a chemical called phenol is applied to the affected area to prevent any nail growing back and causing an ingrown toenail to develop in the future.
During the procedure, any pus that is present in the affected area will be drained away from the toe to prevent the area becoming more infected. If your nail is infected, you may be prescribed a course of antibiotics.
Total nail avulsion
To reduce the risk of an ingrown toenail developing in the future, your whole toenail may be removed. This procedure is known as a total nail avulsion.
Total nail avulsion may be recommended if your nail is thickening and pressing into the skin surrounding your toe. As with partial nail avulsion, this is also carried out using local anaesthetic.
During the procedure, the nail will be removed and you will be left with the indentation (the concave area of skin) where your toenail used to be. It is perfectly safe to not have a toenail and your toe will continue to function normally.
After nail surgery
After having nail surgery, your toe will be wrapped in a bandage to allow the area to heal and to help prevent an infection developing. You should rest your affected foot and keep it raised for one to two days after the operation.
Once the anaesthetic wears off, your toe may be sore and tender. To help alleviate any pain, you may need to take a painkiller, such as paracetamol, and wear soft or open-toed sandals for the first few days following surgery.
You can remove the bandage two days after having nail surgery. Soak your toes with salt water to help the area to heal.
Preventing an Ingrown Toenail
There are a number of measures that you can take to help keep your feet healthy and prevent problems developing. These are described below.
Cutting your nails
Your chances of developing an ingrown toenail are reduced if you cut your nails properly.
Cut your toenails straight across, not at an angle or down the edges because this can cause ingrown toenails. You may find it easier to cut your toenails after having a shower or a bath as they are likely to be softer.
Good foot hygiene
Ensuring good foot hygiene will help prevent problems developing with your feet.
Wash your feet daily with soap and water to keep them clean. After washing, dry your feet thoroughly and apply moisturising foot cream (not body lotion).
Use a foot file or a pumice stone to remove hard skin on a regular basis. You should also change your socks (or tights) every day so that your feet remain as clean and fresh as possible.
Correctly fitting footwear
Wearing comfortable shoes that fit properly is also very important for ensuring that your feet remain healthy, and for avoiding problems such as ingrown toenails.
If your shoes are too narrow or too tight, your toes can become overcrowded. Shoes that are too loose can put pressure on your toes when you walk.
It is better to shop for shoes in the afternoon. Feet swell as the day goes on, so if a pair of shoes fit in the afternoon when your feet are at their largest, it is more likely that they will be comfortable.
Seek medical help
Visit your GP or a podiatrist (foot-care specialist) if you are experiencing problems with your feet. They will be able to examine your feet and give you advice about the right shoes to wear to help your condition improve.