Burlington Podiatry

Michael Guerra, DPM

1540 Williston Road | South Burlington, VT 05403

(802) 862-8666

Ingrown Toenail

What Is an Ingrown Toenail?

When a toenail is ingrown, the nail is curved downward and grows into the skin, usually at the nail borders (the sides of the nail). This "digging in" of the nail irritates the skin, often creating pain, redness, swelling, and warmth in the toe.

If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odor. However, even if your toe isn't painful, red, swollen, or warm, a nail that curves downward into the skin can progress to an infection.

What Causes an Ingrown Toenail?

Ingrown toenails can develop for various reasons. In many people, the tendency to have this common disorder is inherited. In other cases, an ingrown toenail is the result of trauma, such as stubbing your toe, having an object fall on your toe, or engaging in activities that involve repeated pressure on the toes, such as kicking or running.

The most common cause of ingrown toenails is improper trimming. Cutting your nails too short encourages the skin next to the nail to fold over the nail. Another cause of ingrown toenails is wearing shoes that are tight or short.

Certain nail conditions are often associated with ingrown toenails. For example, if you have had a toenail fungal infection or if you have lost a nail through trauma, you are at greater risk for developing an ingrown toenail.

Treatment

Sometimes initial treatment for ingrown toenails can be safely performed at home. However, home treatment is strongly discouraged if you suspect you have an infection, or if you have a medical condition that puts your feet at high risk-for example, diabetes, nerve damage in the foot, or poor circulation.

Home care:

If you don't have an infection or any of the above conditions, you can soak your foot in room-temperature water (add Epsom'.s salt if you wish), and gently massage the side of the nail fold to help reduce the inflammation/

Avoid attempting "bathroom surgery." Repeated cutting of the nail can cause the condition to worsen over time. If your symptoms fail to improve, it's time to see a foot and ankle surgeon.

Physician care:

The foot and ankle surgeon will examine your toe and select the treatment best suited for you. Treatment may include:

  • Oral antibiotics. If an infection is present, an oral antibiotic may be prescribed.
  • Surgery. A simple procedure, often performed in the office, is commonly needed to ease the pain and remove the offending nail. Surgery may involve numbing the toe and removing a comer of the nail, a larger portion of the nail, or the entire nail.
  • Permanent removal. Various techniques may be used to destroy or remove the nail root. This treatment prevents the recurrence of an ingrown toenail. Your surgeon will determine the most appropriate procedure for you.

Following nail surgery, a light bandage will be applied. Most people experience very little pain after surgery and may resume normal activity the next day. If your surgeon has prescribed an oral antibiotic, be sure to take all the medication, even if your symptoms have improved.

Preventing Ingrown Toenails

Many cases of ingrown toenails may be prevented by following these two important tips:

  • Trim your nails properly. Cut your toenails in a fairly straight line, and don't cut them too short. You should be able to get your fingernail under the sides and end of the nail.
  • Avoid poorly-fitting shoes. Don't wear shoes that are short or tight in the toe box. Also avoid shoes that are loose, because they too cause pressure on the toes, especially when you run or walk briskly.

Cutting a notch (a "V") in the nail will reduce the tendency for the nail to curve downward.

Cutting a "V" does not affect the growth of the toenail. New nail growth will continue to curve downward.

Repeated trimming of the nail borders is a good way to treat ingrown toenails.

Repeated nail trimming fails to correct future nail growth and can make the condition worse.

Cotton placed under the nail will relieve the pain.

Cotton placed under the nail can be harmful. It can easily harbor bacteria and encourage infection.

You can buy effective ingrown toenail treatments at the drugstore.

Over-the-counter topical medications may mask the pain, but they fail to address the underlying problem.

Toenail Fungus

What Is Toenail Fungus?

Toenail fungus, or onychomycosis, is an infection underneath the surface of the nail caused by fungi. When the tiny organisms take hold, the nail often becomes darker in color and smells foul. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of spreading to other toenails, the skin, or even the fingernails. If ignored, the infection can spread and possibly impair your ability to work or even walk. The resulting thicker nails are difficult to trim and make walking painful when wearing shoes. Onychomycosis can also be accompanied by a secondary bacterial or yeast infection in or about the nail plate.

Causes

Because it is difficult to avoid contact with microscopic organisms like fungi, the toenails are especially vulnerable around damp areas where you are likely to be walking barefoot, such as swimming pools, locker rooms, and showers, for example. Injury to the nail bed, even pressure from shoes, may make it more susceptible to all types of infection, including fungal infection. Those who suffer from chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributing factors may be a history of athlete's foot and excessive perspiration.

Trying to solve the infection without the qualified help of a podiatrist can lead to more problems. With new technical advances in combination with simple preventive measures, the treatment of this lightly regarded health problem can often be successful.

Prevention

Proper hygiene and regular inspection of the feet and toes are the first lines of defense against fungal nails. Clean and dry feet resist disease.

  • Wash your feet with soap and water, remembering to dry thoroughly.
  • Wear shower shoes when possible in public areas.
  • Change shoes, socks, or hosiery more than once daily.
  • Clip toenails straight across so that the nail does not extend beyond the tip of the toe.
  • Wear shoes that fit well and are made of materials that breathe.
  • Avoid wearing excessively tight hosiery to decrease moisture.
  • Wear socks made of synthetic fiber that "wicks" moisture away from your feet faster than cotton or wool socks do.
  • Disinfect instruments used to cut nails.
  • Disinfect home pedicure tools.
  • Don't apply polish to nails suspected of infection (those that are discolored, for example).
  • Treat athlete's foot, if present.