Ingrown Toenails: Nuisance or Worse?

Tips for Understanding, preventing, and treating ingrown toenails with dermatology specialists Drs. Joshua Fox and Francis DiSpaltro

Ouch! That ingrown toenail – marked by nagging pain, redness, and swelling around your toenail – can certainly slow you down. But ingrown toenails may also be more than just a nuisance and deserve careful attention, says Joshua Fox, M.D., medical director of Advanced Dermatology P.C. “Left undetected or untreated, an ingrown toenail can infect the underlying bone and lead to a serious bone infection,” says Dr. Fox. “Those with diabetes or other circulation problems are at an even greater risk of complications. Many people ignore ingrown toenails, but we should take steps to prevent and treat them, if only for our own comfort.”

Some people are genetically predisposed to ingrown toenails – which usually affect the big toe – but the nail can also grow into the flesh of the toe as a result of wearing tight shoes that crowd your toenails, an injury to the toenail, or – most commonly – by cutting your toenails too short or not straight across. Young men between the ages of 15 and 40 are most likely to cope with the condition, which affects tens of thousands of people of all ages each year, according to a 2012 study in British Medical Journal.

“Ingrown toenails are probably one thing everyone can count on suffering from at least once,” says Dr. Francis DiSpaltro, dermatologist with Advanced Dermatology. “But that doesn’t mean you have to resign yourself to them.”

Tips for preventing ingrown toenails

Along those lines, Dr. DiSpaltro offers several common-sense ways to prevent ingrown toenails. They include:

• Trimming your toenails straight across: Don’t curve nails to match the shape of the end of your toe, and make sure to mention this to your pedicurist if you have your toenails done at a salon. People with diabetes or circulation problems such as peripheral vascular disease should have their nails trimmed professionally by a podiatrist if they can’t do it themselves.
• Keeping toenails at moderate length: Toenails that are even with the top of toes are the right length to keep ingrown nails at bay. Trimmed too short, the pressure on your toes from shoes may drive nails downward into the tissue.
• Wearing properly fitting shoes: Shoes that pinch your toes or exert too much pressure on the tops of toes may trigger nails to grow into surrounding tissue. Those with nerve damage from diabetes or other problems who can’t fully feel their feet may want to be professionally fitted for each new pair at the shoe store.
• Wearing protective footwear when needed: Construction workers or those whose work puts them at risk of foot injury should wear steel-toed shoes to protect from toe impact or pressure.

Treating ingrown toenails

Once a toenail is ingrown, treating it is usually a fairly straightforward process. But sometimes – when an abscess causes severe pain and redness – surgery is called for to alleviate the infection and repair the nail bed so the toenail can once again grow properly. Typically, however, home treatment measures will do the trick. They include:

• Soaking the foot: A solution of lukewarm water and mild soap not only feels good, but helps reduce swelling and clear the skin of pus or other signs of irritation. Soak for 15 to 20 minutes twice a day.
• Place cotton or floss under the nail: After soaking, when skin is soft, place bits of cotton or waxed dental floss under the ingrown nail edge to help the nail gradually grow above the skin. Change daily.
• Apply antibiotic cream: This helps reduce redness. Place a bandage over the area before wearing socks or shoes.
• Choose open-toed shoes: If possible, open-toed shoes or sandals will keep the pressure off while your toenail area heals.
• Try pain relievers: Over-the-counter pain relievers such as ibuprofen or acetaminophen can take the edge off pain. If pain persists, see your doctor.

“If home treatments for an ingrown toenail don’t work, don’t hesitate to see a doctor,” Dr. Fox says. “Surgery may seem extreme, but sometimes it’s the only way to prevent an infection from spreading into the bone or blood stream and causing a much larger problem. Nail health, as mundane as it seems, is important to overall health and well-being.”