Freelance Writing Jobs | Today's Articles | Sign In

Ingrown Toenails

Management of a Common But Painful Foot Condition

Mar 20, 2009 Stephen Allen Christensen

Most people have probably experienced the discomfort of an ingrown toenail. While the topic is mundane, recurrent ingrown nails can significantly impact a person's life.

Approximately 20% of individuals who consult a physician for a foot problem do so because of an ingrown toenail. Ingrown toenails occur when the skin surrounding the nail is punctured by the nail border. This leads to a foreign body response with inflammation, swelling, drainage, and secondary infection (paronychia).

Causes of Ingrown Toenails

Ingrown toenails are believed to result from improper nail trimming (or tearing of the nails). This results in the creation of a nail barb which then penetrates into the soft tissues of the toe as the nail grows.

Multiple other factors probably contribute to ingrown toenails, but there is little evidence that one factor is more important than another. Constrictive footwear, abnormal gait (e.g., toe walking), inherited variations in nail shape, foot edema, poor foot hygiene, excessive sweating, repeated toe trauma (e.g., kicking), injury to the nail bed, abnormalities in the bone beneath a nail, and even toe shape have all been implicated.

Due to their tendency to suffer from foot swelling, people with diabetes, congestive heart failure, kidney disease, obesity, or thyroid disorders seem to develop ingrown toenails more frequently. With aging, toenails naturally thicken, making them more difficult to trim neatly. Thus, elderly individuals are more prone to develop ingrown toenails.

Treatment of Ingrown Toenails

When an ingrown toenail is obviously infected or causes a great deal of pain, treatment by a medical professional is warranted. This usually involves the administration of antibiotics as well as a minor surgical procedure to remove at least part of the ingrown nail.

For less severe ingrown nails, or for people who cannot tolerate or do not wish to proceed to surgery, conservative measures may provide relief and help to avoid a surgical procedure:

Soak the affected foot in warm, soapy water for 20-30 minutes several times daily (some podiatrists recommend adding ½ to 1 cup of vinegar to the soaking solution).
Following the soak, apply a topical antibiotic ointment (e.g., Neosporin) or a corticosteroid ointment to the affected area.
Cover with a Band-aid or similar dressing.
Unless the toe is exquisitely tender, placing a “shim” (wisps from a cotton ball or a strip of dental floss) beneath the nail edge prior to application of antibiotic or anti-inflammatory ointment may help the nail to grow outward. The edge of the nail can be elevated with a small curette, a cuticle stick, or a nail elevator to install the shim.
A gutter splint can be fashioned from a short length of a hollow stirring straw—or a similar device—that has been split up one side and cut diagonally on one end to allow smooth insertion. The gutter splint is secured with adhesive tape, a Band-aid, or cyanoacrylate glue (e.g., Super Glue).
A sculptured acrylic artificial nail can be affixed to the ingrown nail’s surface. This may help the nail to grow in a more normal fashion and pull the nail barb toward the surface.

Conservative measures should be continued until the nail has grown over the tip of the toe (two to twelve weeks).

How to Prevent Ingrown Toenails

Wear shoes with wider toe boxes.
Trim toenails in a relatively flattened plane, leaving the nail corners beyond the end of the nail fold. Avoid rounding the corners, clipping the corners down, or cutting the nails too short.
Keep feet clean and dry. If necessary, wear cotton socks and change them during the day.
Avoid repetitive toe trauma.

(From The Merck Manual, 18th Edition 2006:345-46 and Heidelbaugh J, Lee H. Management of the ingrown toenail. Am Fam Phys 2009;79(4):303-308)

The copyright of the article Ingrown Toenails in General Medicine is owned by Stephen Allen Christensen. Permission to republish Ingrown Toenails in print or online must be granted by the author in writing.

Gutter Splint for Ingrown Toenail