Ingrown Nail

Overview

An ingrown nail occurs when the edge or corner of a nail grows into the soft skin beside it instead of over it. It most often affects the big toe and causes pain, redness, and swelling along the edge of the nail. While usually a minor problem, an ingrown nail can become infected and quite painful, and it sometimes returns if the underlying cause is not addressed.

Ingrown nails are very common and are often linked to tight footwear, cutting the nails too short or rounded, or injury to the toe. Many mild cases can be managed at home, but more severe or infected ones, and those in people with diabetes or poor circulation, need medical care. A simple in-office procedure can treat stubborn or recurring ingrown nails effectively.

Symptoms

Symptoms usually develop along one edge of the nail and may worsen over time:

• Pain and tenderness at the side of the nail, especially with pressure from shoes
• Redness and swelling of the skin beside the nail
• A feeling that the nail edge is digging in
• If infected: increasing pain, warmth, pus or discharge, and a bad smell
• Sometimes overgrown tissue beside the nail

In the early stage the area may simply be sore and red; if it progresses, signs of infection such as pus and spreading redness can appear.

Causes

An ingrown nail happens when the nail edge presses into and pierces the surrounding skin. Common causes and contributors include:

• Improper nail trimming: Cutting nails too short or rounding the corners, which encourages the edge to grow into the skin.
• Tight or narrow footwear: Shoes that crowd the toes and press on the nail.
• Injury: Stubbing the toe or repeated pressure, as in some sports.
• Naturally curved nails: Some people have nails that tend to curve into the skin.
• Sweaty feet or poor foot hygiene: Softening the skin so the nail penetrates more easily.

Risk Factors

• Cutting toenails too short or curved
• Wearing tight, narrow, or ill-fitting shoes
• Toe injuries or activities with repeated toe pressure
• Naturally thick or curved nails
• Diabetes or poor circulation (raises the risk of complications)
• Excessive foot sweating

Diagnosis

An ingrown nail is diagnosed by looking at the affected toe:

• Examination: The nail edge growing into red, swollen skin is usually obvious, and the doctor checks for signs of infection.
• Assessing severity: Whether there is simple irritation, infection with pus, or overgrown tissue helps guide treatment.
• Checking circulation and sensation: Especially important in people with diabetes or poor circulation, who are at higher risk of complications.

Treatment

Treatment depends on the severity and whether there is infection:

• Home care for mild cases: Soaking the foot in warm water several times a day, keeping the area clean and dry, wearing roomy footwear, and gently easing the skin away from the nail edge. Avoid digging out the nail or cutting a notch in it.
• Antibiotics: If there is infection with pus and spreading redness.
• Lifting the nail: A doctor may place a small piece of cotton or a splint under the nail edge to help it grow over the skin.
• Nail procedure: For severe or recurring cases, part of the nail edge can be removed under local anesthetic. Sometimes the nail-forming tissue along that edge is treated to prevent regrowth.

People with diabetes or poor circulation should not attempt home surgery and should seek professional foot care for any ingrown or infected toenail.

Prevention

• Trim toenails straight across, not too short, and avoid rounding the corners
• Wear shoes and socks that give the toes enough room
• Keep feet clean and dry
• Protect toes from injury during sports and activities
• If you have diabetes, inspect your feet regularly and get professional nail care

When to See a Doctor

See a doctor if an ingrown nail is very painful, shows signs of infection (pus, spreading redness, warmth), or keeps coming back. Seek prompt care, and do not treat it yourself at home, if you:

• Have diabetes, nerve damage, or poor circulation in the feet
• Notice the redness spreading up the foot or develop a fever
• Have a non-healing sore or significant discharge

In people with diabetes or poor circulation, even a minor foot infection can become serious, so early professional care is important.

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine. Ingrown toenail.
2. American Academy of Dermatology. How to treat an ingrown toenail.
3. Mayo Clinic. Ingrown toenails.
4. American Podiatric Medical Association. Ingrown toenails.