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Ingrown toenail

Definition

An ingrown toenail occurs when the edge of the nail grows down and into the skin of the toe.

Alternative Names

Onychocryptosis; Unguis incarnatus; Nail avlusion; Matrix excision

Causes

An ingrown toenail can result from a number of things. Poorly fitting shoes and toenails that are not properly trimmed are the most common causes. The skin along the edge of a toenail may become red and infected. The great toe is affected most often, but any toenail can become ingrown.

Ingrown toenails may occur when extra pressure is placed on your toe. This pressure is caused by shoes that are too tight or too loose. If you walk often or participate in athletics, a shoe that is even a little tight can cause this problem. Deformities of the foot or toes can also place extra pressure on the toe.

Nails that are not trimmed properly can also cause ingrown toenails.

Some people are born with nails that are curved and grow downward. Others have toenails that are too large for their toes. Stubbing your toe or other injuries can also lead to an ingrown toenail.

Symptoms

There may be pain, redness and swelling around the nail.

Exams and Tests

An exam of the foot will show the following:

Tests or x-rays are usually not needed.

Treatment

If you have diabetes, nerve damage in the leg or foot, poor blood circulation to your foot, or an infection around the nail, go to the doctor right away. Do not try to treat an ingrown nail at home.

Otherwise, to treat an ingrown nail at home:

When trimming your toenails:

Consider wearing sandals until the problem goes away. Over-the-counter medication that is applied to the ingrown toenail may help with the pain, but it does not treat the problem.

If this does not work and the ingrown nail gets worse, see your family doctor, a foot specialist (podiatrist) or a skin specialist (dermatologist).

If your ingrown nail does not heal or keeps coming back, your doctor may remove part of the nail:

Sometimes your doctor will use a chemical, electrical current, or another small surgical cut to destroy or remove the area from which a new nail may grow.

If the toe is infected, your doctor may prescribe antibiotics.

Outlook (Prognosis)

Treatment usually controls the infection and relieves pain. The condition is likely to return if you do not practice good foot care.

This condition may become serious in people with diabetes, poor circulation, and nerve problems (peripheral neuropathies).

Possible Complications

In severe cases, the infection can spread through the toe and into the bone.

When to Contact a Medical Professional

Call your health care provider if you:

If you have diabetes, nerve damage in the leg or foot, poor blood circulation to your foot, or an infection around the nail, your risk for complications is higher. If you have diabetes, see your health care provider.

Prevention

Wear shoes that fit properly. Shoes that you wear every day should have plenty of room around your toes. Shoes that you wear for walking briskly or for running should also have plenty of room, but not be too loose.

When trimming your toenails:

Keep your feet clean and dry. People with diabetes should have routine foot exams and nail care.

References

Heidelbaugh JJ, Lee H. Management of the ingrown toenail. Am Fam Physician. 2009;79(4):303-8.

Ishikawa SN. Disorders of nails and skin. In: Canale ST, Beaty JH, eds. Campbell’s Operative Orthopaedics. Philadelphia, Pa.: Elsevier Mosby; 2012:chap 87.



Review Date: 4/16/2013
Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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