ingrown Toenail: causes, symptoms and treatment

What are the common causes of an ingrown toenail?

The number one cause of ingrown toenails is ill-fitting shoes, but there are many other things that can contribute to ingrown toenails. Some of those causes include:

• Painful ingrown nails may be congenital. In this instance, they are caused by an over-curvature of the nail or an imbalance between the width of the nail plate and nail bed.
• Toe injuries that change the nail's contour may also lead to an ingrown toenail.
• Toe deformities (such as a bunion that forces the big toe to lean toward the second toe).
• Wearing high-heeled or narrow, pointed shoes can put pressure on the nail and surrounding soft tissue, eventually forcing the nail to grow into the skin.
• Poor nail care, such as trimming the nail too short, rounding it at the tip, or peeling it off at the edges, can cause an ingrown nail.

What are conservative treatment options for an ingrown toenail?

At University Foot & Ankle Institute, our foot experts opt for non-surgical, conservative treatment options whenever possible. 

Some conservative ingrown toenail treatments and home remedies include:

• Soaking the foot/toe in warm water and Epsom salt for 10 minutes twice a day.
• Applying topical antibiotic ointment and a bandage to prevent or treat infection.
• Over-the-counter pain relievers such as ibuprofen or acetaminophen can relieve pain while the toenail heals.

While many ingrown toenails can be treated at home, you should see medical attention if there are signs of infection. Signs of an infected ingrown toenail include swelling, pus, redness at the corner of the nail, extreme pain, and fever.

Those with diabetes, nerve damage, or poor circulation should also seek prompt medical attention to prevent complications.

What are ingrown toenail surgical treatment options?

Surgery is often necessary to ease the pain and remove the offending nail. We may only remove a portion of the nail. However, if the entire nail is affected or there is a severe nail deformity, the nail plate and matrix (the cells that grow the nail) may be completely removed.

Partial nail avulsion 

For some cases of ingrown nails, only the part of the nail that is growing into the skin is removed. If both sides of the nail are ingrown, they may be removed during one procedure.

Complete nail removal 

Complete removal of the nail plate is another remedy for ingrown nails. During this procedure, also known as nail plate avulsion, the entire nail is removed.

Removing the entire toenail increases the likelihood of it growing back in an irregular or deformed manner, which can lead to a higher chance of experiencing ingrown toenails in the future. The regrowth of the nail can take as long as 18 months to complete.

Matrixectomy surgery

During this procedure, the nail plate is removed, and the nail matrix (the tissue under the nail that is responsible for the growth of fingernails and toenails) is destroyed. There are two ways to perform this treatment:

• • Phenol - An acidic chemical called phenol is applied only to the nail matrix. This destroys the growth cells of the nail.
  • Surgical removal - The nail matrix and bed is cut away. Stitches are only occasionally necessary.

Removal of bone overgrowth 

Bone directly beneath the nail plate may become enlarged, developing a spur or outgrowth that can deform the nail plate or lead to an ingrown nail. Removal of excess bone may be performed concurrently with surgery to partially or permanently remove the nail plate.

What is ingrown toenail surgery recovery like? 

Most people experience very little pain immediately following ingrown nail surgery and during the healing process, which lasts about two to three weeks. Wearing loose-fitting or open-toed shoes for about two weeks after surgery will give your toe room to heal. 

You will have a longer healing process if bone has to be removed during surgery. During your pre-surgery consultation, our orthopedic surgeon will go over all instructions and timelines for your recovery.

The connection between ingrown toenails and paronychia 

Paronychia is a skin infection that occurs around fingernails and/or toenails. It is one of the most common toenail infections and is often caused by an ingrown toenail. Common symptoms of paronychia include swelling around the toenail, redness, pus, and tenderness.

Soaking your toe in warm water or a mixture of warm water and antibacterial soap for about 15 minutes can help reduce pain and swelling. The soaking should be done at the first sign of redness around the nail and repeated three to four times daily.

If an abscess (collection of pus under the skin) becomes visible, you should see our foot and ankle specialist for oral antibiotics and possible drainage.

University Foot and Ankle Institute, your best treatment choice for all toenail conditions

Our podiatrists have extensive experience diagnosing and treating ingrown toenails. We realize this condition can be both painful and unsightly. Accurate diagnosis and treatment are the hallmarks of the University Foot and Ankle Institute care.

To schedule a consultation, please call (855) 872-5249 or make an appointment now.

University Foot and Ankle Institute podiatry group is conveniently located throughout Southern California and the Los Angeles area. Our foot doctors are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Santa Barbara, and Valencia.

Frequently Asked Questions about Ingrown Toenails and Toenail Removal

 

How long does ingrown toenail surgery take?

Generally, it will take our doctor an hour or less to perform the procedure.

 

Is toenail removal generally covered by insurance?

Yes, in many cases it is. University Foot and Ankle Institute accepts close to 1000 different insurance plans. You can check our insurance page to see if yours is among them.

 

If you do not see your plan please call the office at (877) 989-9110 and tell them what your plan is and they can confirm if we accept it.

 

Can I wear shoes after ingrown toenail removal surgery?

It's typically advised to wear loose, comfortable shoes or open-toed footwear to avoid pressure on the toe. Tight or constrictive shoes might exacerbate pain, cause irritation, or interfere with the healing process.

 

 

Sources 

Chapeskie H, Kovac JR. Case Series: Soft-tissue nail-fold excision: a definitive treatment for ingrown toenails. Can J Surg 2010;53:282–6. https://pubmed.ncbi.nlm.nih.gov/20646404/

Eekhof JAH, et al. Interventions for ingrowing toenails. Cochrane Database of Systematic Reviews. http://www.thecochranelibrary.com. Accessed Oct. 12, 2021.

Richert B, Rich P. Nail surgery. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 149.