Walk a Mile in my Shoes - Toe Woe: Ingrown Nails - April 2012

By Miscellaneous

Ingrown toenails are a common, painful foot problem. Medically called onychocryptosis, an ingrown toenail occurs when the nail, usually on the big toe, punctures the surrounding skin causing inflammation and sometimes infection. If you tend to get them, here are the steps to take.

The main cause of ingrown toenails is improper trimming of the nail, made worse by walking, especially if you wear tight or improperly fitting shoes or are very overweight. Trauma to the nail can also contribute to an ingrown toenail, as may swelling in the feet. As you age, your toenails get thicker, making it more difficult to trim them well.

It’s unclear whether the shape of the toenail (an inherited factor), plays a role. Some researchers think the problem may be with the soft tissue around the nail, not the nail itself. One small study found that people with ingrown toenails tend to have thin, flat nails and wide, fleshy soft tissue around them. An excessively curved toenail that naturally curls under at the sides instead of growing flat across, may also be more likely to become ingrown. Another study, however, found no anatomical differences in toenails between those with and without ingrown toenails.

Left untreated, the entire side of the nail can become embedded in the skin, increasing the risk of infection, which, if severe, can spread to the rest of the toe and even the foot. If you have recurrent ingrown nails or worsening pain from one, see your doctor or a podiatrist. If you have diabetes, see a health professional for any foot problem.

Treatment of ingrown toenails may include:

  • For mild cases, soak your toe in warm water to soften the nail. Then, if possible, place a small piece of dental floss or cotton under the nail to keep it from cutting the skin. Repeat daily until the nail grows out. Some doctors may attach a small slit tube around the edge of the ingrown nail (a gutter splint). Don’t try to cut out an ingrown toenail yourself.
  • For more severe cases, your doctor may cut away part (or all) of the toenail. For recurrent problems, chemicals or other procedures may be used to destroy part of the nail matrix to keep the nail from growing back. This can change the appearance of the nail, however, and there can still be recurrences. Though rarely done, an alternative may be to remove the soft tissue on both sides of the nail, preserving the nail—a procedure that, according to some research, has a low recurrence rate and does not change the way the toe looks. 
  • Another possible treatment involves filing the nail down to thin and flatten it, thereby reducing its curviness. In a small Turkish study, no recurrences occurred over six months after this treatment.

Keeping things straight
To prevent an ingrown toenail, trim your toenails straight across, with no rounded corners, and not too close. Smooth the edges with an emery board or nail file and clean the grooves at the sides with an “orange stick” manicure tool. If you can’t trim your nails yourself, consider regular visits to a podiatrist (insurance should cover the cost) or professional pedicures. It’s a myth that cutting a “V” in the middle of the toenail will prevent or cure an ingrown toenail. If you’re prone to ingrown toenails, it’s especially important to pay attention to the fit of your footwear, avoiding tight shoes and high heels.


Happy Walking!


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