Ingrown Toenail

WHAT IS AN INGROWN TOENAIL?
An ingrown toenail occurs when a section of the nail curves into the flesh of the toe and becomes embedded in the soft tissue. It can occur on all toes, but almost always affects the big toe. Sometimes callused or red granulation tissue ("proud flesh") grows over the embedded edge. If dirt and sweat enter this area, infection can occur, causing the skin at the side or tip of the nail to become red, swollen and tender. Sometimes, a small amount of pus can be seen exiting from the embedded area. This type of infection is called a paronychia.

WHAT CAUSES IT?
While many things can cause ingrown toenails, two major causes are poorly fitting shoes and improperly trimmed nails. Shoes that are too tight press the sides of the nail and encourage it to curl in. Nails that are peeled off at the edge or trimmed down into the corners are also more likely to become ingrown. Paronychias are typically caused from overzealous manicuring, nail biting, diabetes mellitus, and occupations in which the hands are frequently immersed in water.

HOW IS IT TREATED?
If the toe is infected, soaking in warm, soapy water as often as possible is recommended - at least 3 or 4 times daily. If the infection is more severe, oral antibiotics may become necessary. When infection occurs, or discomfort from the ingrown nail is severe, minor surgery to remove part, or all, of the nail may be necessary. If surgery is performed, you will need to avoid physically strenuous activities for two weeks post operatively.

CAN IT BE PREVENTED?
Several steps can be taken to decrease the risk of developing ingrown toenails.

• Cut nails straight across without tapering the corners, which should reach out from the toe, as shown in the illustration. This is probably the most important factor in preventing ingrown toenails.
• Avoid wearing shoes and socks that are too tight.
• Keep feet clean to prevent the ingrown nail from becoming infected.

Properly trimmed toenail	Improperly trimmed toenail

References
Hecht, A. (1985). Caring for Corns, Bunions and Other Agonies of De-Feet. FDA Consumer, June, pp. 23-24. Larson, D. E. (Ed.). (1990). Mayo Clinic Family Health Book. New York: William Morrow and Company. American Academy of Family Physicians (7/95).

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