Ingrown Toenails

Introduction

Ingrown toenails are a common condition in adults.  They occur when the corner of a toenail grows into the skin or when the skin grows over the toenail.  Ingrown toenails cause pain and swelling.  If left untreated, they can lead to infection.  In some cases, ingrown toenails can be treated at home.  A doctor should treat an ingrown toenail if home treatments fail, you are at risk for infection, or you suspect that your ingrown toenail is infected.
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Anatomy

Your toenails are made of a hard protein called keratin.  They cover the nail beds on your toes.  The nail bed, also called the nail matrix, contains blood vessels, nerves, and color producing cells.  Your toenail has a root that extends underneath your skin.  Toenail growth begins at the root of the toenail and continues as the toenail grows across the nail bed.  A toenail grows very slowly.  It usually takes a toenail a year or more to grow out and replace itself.
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Causes

Ingrown toenails most frequently occur in the big toe, although any toe can be affected.  There are several causes of ingrown toenails.  Ingrown toenails can result from wearing high heels or shoes that are too tight in the toe area.  Pressure from a poor fitting shoe causes the toenail to grow abnormally.  Tight fitting socks have the same effect.
 
Ingrown toenails can result from poorly shaped toenails.  Toenails should be trimmed straight across and not rounded.  Some medical conditions, such as fungal infections or arthritis, can cause toenails to thicken and grow abnormally.  Additionally, ingrown toenails can result from toe injury.
 
If left untreated, ingrown toenails can become infected.  Infections can lead to abscesses that require surgery.  Infections are especially concerning for people with diabetes, poor circulation, and AIDS, or those receiving chemotherapy.
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Symptoms

Ingrown toenails cause pain.  Your skin surrounding the toenail may appear red and have mild swelling.  Your skin may feel warm to the touch. 
 
If an ingrown toenail becomes infected, the redness and swelling gets worse.  A white or yellow colored discharge may drain from the area.  You may develop a fever although this rarely occurs.
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Diagnosis

A doctor can diagnose an ingrown toenail by examining your toe.  You should tell your doctor about your symptoms and risk factors.  It is important to tell your doctor about your medical conditions, medications, allergies, and when you had your last tetanus shot. 

You doctor will conduct a general physical examination.  Your doctor will determine if the area is infected.  Blood tests may be performed if you have a severe infection and diabetes or a serious medical condition.
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Treatment

In some cases, ingrown toenails can be treated at home.  You should soak your toe in warm water several times a day.  Over-the-counter products can help reduce the swelling and promote healing.  Protect your toe with a soft foam toecap or gauze.  As your toenail grows out, trim it straight across.
 
If you have a medical condition that puts you at risk for infection, such as diabetes or AIDS, you should not  treat ingrown toenails at home.  You should contact your doctor immediately for professional treatment.  Anyone that is not getting results with home treatment or suspects that they have an infection should contact their doctor. 
 
A doctor can professionally trim or correct an ingrown toenail in his or her office.  Your doctor can safely remove excess skin around the toenail.  He or she can prescribe antibiotics to prevent infection and update your tetanus shot.  In severe or recurring cases, surgery, laser surgery, or chemicals may be used to treat an infected or ingrown toenail.
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Prevention

You can prevent ingrown toenails from occurring or recurring after treatment.  Clip your toenails straight across.  Keep your feet clean and dry.  Wear shoes and socks that fit well.  If you have a foot deformity or diabetes-related foot problems, talk to your doctor about having custom shoes made.  Custom shoes provide your feet with proper support and may be helpful for preventing medical complications.
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Am I at Risk

Risk factors may increase your likelihood of developing ingrown toenails.  People with all of the risk factors may never develop the condition; however, the chance of developing ingrown toenails increases with the more risk factors you have.  You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for ingrown toenails:

_____ People with curved or abnormally shaped toenails
_____ Wearing shoes that are too tight in the toe area or high heels
_____ Poorly trimmed toenails
_____ Toe injuries
_____ Certain medical conditions, such as toenail fungal infections and arthritis

People with diabetes, poor circulation, AIDS, or receiving chemotherapy have an increased risk of developing an ingrown toenail infection.  Such people at high risk for infection should contact their doctor immediately if they develop an ingrown toenail.

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Complications

Infections are a complication of ingrown toenails.  The area surrounding the toes is a warm moist environment in which germs thrive.  Infections are especially concerning for people with medical conditions that increase their risk for infection including people with diabetes, poor circulation, AIDS, or those receiving chemotherapy.  Infections can lead to abscesses that require surgery.  If untreated, infections can spread to the rest of the body.  Anyone with a suspected infection should contact his or her doctor immediately.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.