4 min read
An ingrown toenail is one of the smallest problems a foot can have and one of the most distracting. It is usually the big toe, it hurts every time a shoe or a bedsheet touches it, and nearly everyone starts by trying to fix it themselves. Sometimes that is enough. This article is about the times it is not, and how to tell which one you are dealing with.
What is actually happening
A toenail is ingrown when its edge or corner presses into the skin beside it instead of growing out over it. The skin responds the way it would to a splinter: it becomes red, swollen and tender. If the nail edge breaks the skin, bacteria that live on everyone's feet have a way in.
The big toe is by far the most common site, and the usual contributors are ordinary ones:
- Trimming nails too short or rounding the corners, which lets the skin fold over the nail edge.
- Shoes or boots that are tight across the toes. Steel-toed and other stiff work boots worn for long shifts are a frequent part of the story.
- An injury to the toe, such as stubbing it or dropping something on it.
- The shape of the nail itself. Some nails are naturally more curved, and that tends to run in families.
Why cutting it out yourself tends to backfire
The instinct is to dig out the corner that hurts. Foot and ankle surgeons have a name for this, "bathroom surgery", and they advise against it for a practical reason: it often leaves a sharp spike of nail deeper in the fold than you can see or reach. That spike keeps growing forward into skin that is already inflamed.
The result is a familiar loop. The toe feels better for a few days because the pressure is off, then worse than before as the nail grows back in. Repeated cutting can make the condition harder to settle over time, and each attempt is another chance to open the skin.
When it has become an infection
Soreness and a little redness beside the nail are the early stage. These are the changes that suggest the toe has moved past that:
- Redness and swelling that are spreading away from the nail edge rather than staying beside it.
- Drainage, whether clear, yellow, or tinged with blood.
- Warmth in the toe, or throbbing pain that continues when nothing is touching it.
- Extra tissue building up along the nail edge, often red, moist and quick to bleed.
Who should not wait and see
For most healthy adults an ingrown nail is a nuisance. For some people it is not a small thing at all, and home treatment is discouraged from the start:
- People with diabetes. Reduced circulation and reduced sensation mean a minor break in the skin of the foot may not heal normally, and may not be felt as it worsens.
- People with neuropathy or poor circulation in the feet from any cause.
- Anyone with signs of infection, as listed above.
- Anyone on their second, third or fourth round with the same toe. A nail that keeps growing in is unlikely to stop on its own.
What a visit for an ingrown toenail involves
The toe is examined to see how far the nail edge has grown in and whether infection is present. From there the options are explained, and they range from simple measures to a short in-office procedure on the edge of the nail, done with the toe numbed. For nails that return again and again, there is a version of that procedure intended to keep that edge from growing back.
Which of those is appropriate depends on the toe and on your general health, and that is the conversation the visit is for.
Coming to us from outside Chillicothe
Bends Foot and Ankle has one office, at 37 N Plaza Blvd in Chillicothe, Ohio. Patients from the surrounding towns are seen there, and each of these pages covers the drive in:
- Waverly, Ohio: about 25 minutes · about 20 miles · US-23 north
- Circleville, Ohio: about 25 minutes · about 18 miles · US-23 south
- Frankfort, Ohio: about 15 minutes · about 14 miles · US-35 east
- Jackson, Ohio: about 35 to 40 minutes · about 33 miles · US-35 west
If a toenail has been sore for more than a few days, has started to drain, or is back for another round, it is reasonable to have it looked at rather than keep trimming. Ingrown toenails are one of the most common things we see at our office in Chillicothe.
This article is general information about a common foot and ankle condition. It is not medical advice and it is not a diagnosis of your own symptoms. If something is wrong with your foot, have it examined.
Care at Bends Foot and Ankle is provided by Eric Storts, DPM, FACFAS, board certified podiatric foot and ankle surgeon.