I have an Ingrown toenail, how can I treat it?

Ingrown toenails are an often painful and common foot and ankle problem.  They can result from many different causes, including nail trauma, toenail fungus, hereditary nail shape and others.  When an ingrown toenail occurs, the nail grows in a curved fashion downward into the skin instead of flat and along the nail plate. This causes the toenail to cut into the skin, which allows easier access for bacteria to enter the area and cause infection. Symptoms can include pain, redness, drainage, and swelling of the toe. The most common area for ingrown toenails to occur is on both sides of the big toe. 

When an ingrown occurs, you should seek treatment.  At your appointment, you can expect a consultation and an examination of your foot and nails.  There are multiple treatment options which can be pursued and potentially recommended depending on the extent and severity of the ingrown nail, as well as the potential presence of infection (called a paronychia).  Below are options your foot and ankle doctor may discuss with you.

• Foot soaks, and antibiotics: In cases of significant infection, with cellulitis and drainage, it may be recommended to take a short course of an oral antibiotic, and perform daily foot soaks to allow for improvement or resolution of infection prior to definitive procedure.
• Nail avulsion: Your toe will initially be anesthetized with local anesthetic.  Once numb, the affected border or in severe cases the entire nail will be removed.   With this procedure, the nail will be allowed to regrow.  During this period, depending on the initial cause of the ingrown, topical anti-fungal medications may be recommended.  
• Matrixectomy: For this procedure, like the avulsion, your toe will initially be anesthetized with local anesthetic.  Once numb, the affected border, or in severe cases the entire nail will be removed.  Following removal, a chemical called phenol will be applied to the nail matrix (where the new nail grows from) to prevent either the removed border or entire nail to regrow.  

After these procedures, you will be instructed to soak the toe in warm water and epsom salt for 2 weeks to allow for any drainage to be expressed and to help prevent infection after the procedure.  You will be sent home with detailed post-procedure care instructions for your reference.  

To prevent ingrown toenails, it is recommended to cut the nails straight across, and to not cut the nails too short, leaving them past the skin fold at either side.  Additionally, avoid “home surgery” on a nail if you feel as though it may be ingrown.  This often is unsuccessful, or makes the problem worse.  It also can leave you more prone to infection.  

If you note pain, swelling, redness, warmth, or drainage from an ingrown nail, contact our offices to schedule an appointment for an evaluation and potentially a procedure. 

Author

Dr. Evan Smith Dr. Evan Smith is a Board-Qualified foot and ankle surgeon, providing personalized, high-quality care to the Castle Rock community as a physician with Castle Rock Foot & Ankle Care. Dr. Smith received a Bachelor of Science degree in Biology from Illinois Wesleyan University. He then went on to earn a Doctor of Podiatric Medicine degree at Des Moines University College of Podiatric Medicine and Surgery in Des Moines, Iowa, where he received The American Board of Podiatric Medicine Graduate Merit Award. Following medical school, he completed a three-year foot and ankle surgical residency program at Legacy Health in Portland, Oregon, gaining comprehensive training in all aspects of foot and ankle surgery. Dr. Smith takes pride in connecting with his patients and providing personalized care to get patients back to the activities they love.