Dr. Tariq Jagnarine
Fam Med, Endocrinology/ Diabetes

Home remedies and self-care may help with an ingrown toenail. These include soaking the feet and wearing wider shoes. In some cases, surgery may be necessary. An ingrown toenail occurs when the edges or corners of the nail grow into the skin next to the nail and break the skin. It can be painful and can lead to an infection.
An ingrown toenail is a common condition, but it can cause swelling, redness, and sometimes infection. It usually affects the big toe on either one or both sides. People can usually treat ingrown toenails at home. However, if the pain is severe or spreading, it may be necessary to see a healthcare professional in order to relieve symptoms and prevent further complications. If a person has a badly ingrown toenail, they may need to see a foot specialist (podiatrist) for treatment.

Here are some of the causes of ingrown toenails:
• Footwear: Shoes and socks that crowd the toes and are too tight increase the chance of an ingrown toenail.
• Cutting the toenails too short: Not cutting straight across, or cutting the edges of the toenail can encourage the surrounding skin to fold over the nail. The nail can then be pushed into that skin and pierce it.
• Toenail injury: Dropping something on the toe, kicking something hard, and other accidents can lead to ingrown toenails.
• An unusual curvature: This increases the risk that the toenail will grow into soft tissue, causing inflammation and possible infection.
• Posture: How a person walks or stands can affect the likelihood of developing ingrown toenails.
• Poor foot hygiene or excessive sweating: If the skin on the toes and feet is moist and warm, there is a higher chance of developing an ingrown toenail. A fungal infection can increase the risk.
• Heredity: Ingrown toenails can run in families.
• Genetic factors: Some people are born with larger toenails.

The symptoms of an ingrown toenail include:
• Pain in response to pressure.
• Tender, swollen, or hard skin next to the nail.
• Inflamed skin at the top of the toe
• Bleeding from the ingrown toenail
• White or yellow pus in the affected area
• Fluid buildup in the affected area

A person should treat ingrown toenails as soon as symptoms appear, especially if they have diabetes, nerve damage in the foot or leg, or poor circulation in the foot. Otherwise, complications can occur, such as infections. The American College of Foot and Ankle Surgeons advises consulting a healthcare professional rather than using over-the-counter (OTC) medications. OTCs may mask the pain, but they do not resolve the underlying problem.
A person should consult a doctor if they have:
• Diabetes
• Peripheral vascular disease (varicose veins and darkening of foot)
• Circulatory problem
• Symptoms do not go away.
• Infection develops.
When the nail pierces the skin, bacteria can enter the wound. This can result in infection and cause the following symptoms to occur in the affected areas: redness, swelling, warmth, bleeding, and pus.
Anyone with symptoms of infection should seek medical help, either with a primary care physician, orthopedic surgeon, or podiatrist.
• Removal
If the problem remains, the doctor or podiatrist may recommend removing part or all the nails through surgery. During this type of surgery, a person can expect to:
• Receive a local anesthetic.
• Have one or both edges of the nail removed.
• Have the root of the nail destroyed using a chemical called phenol.
Once part of the nail begins to grow back, the podiatrist may place a piece of cotton wool under the nail. This will stop it from digging into the skin. It is important to change the cotton wool every day. Keeping the same cotton wool increases the risk of infection, as the nail provides a place for harmful bacteria to grow. If the area is infected, the doctor may prescribe antibiotics.
The healing time for this procedure is 4–6 weeks.
• Total nail avulsion
If the ingrown toenail keeps returning, a podiatrist may remove the cells in the nail bed so that the toenail cannot grow again.

Home remedies
Often, a healthcare professional will advise someone to treat the nail themselves. If a person suspects they may have an ingrown toenail, it is important to keep the area clean and dry in order to prevent infection.
• Soak the foot in warm water 3–4 times a day, while using a cotton bud to gently push the skin away from the toenail. A doctor may advise you to add Epsom salts to the warm water.
• Avoid repeatedly cutting the toenail, as this can make the problem worse.
• Wear footwear that leaves the toes plenty of room for movement.

To prevent ingrown toenails from developing:
• Cut the nails correctly: People should cut straight across the nail, not rounded at the corners, and not too short. It is easier to cut the nails after a bath or shower.
• See a podiatrist regularly: A person can visit a podiatrist for professional trimming, especially if they have circulatory problems in the feet or cannot cut their own nails. People with diabetes or peripheral vascular disease need to be particularly careful.
• Maintain hygiene and dryness: An ingrown toenail is less likely if the feet are clean and dry.
• Choose footwear that fits properly: Shoes must be the right length and width. Tight shoes cause pressure, but if shoes are too loose, the toes may hit against the tip of the shoe. This also adds pressure, and could cause an ingrown toenail.
An ingrown toenail is a common condition that can cause pain and swelling. People can usually prevent them by maintaining hygiene and dryness on the feet. Healthcare professionals recommend following certain self-care practices: such as cutting nails correctly, and wearing shoes that fit well. However, if the pain is severe, or a person has a badly ingrown toenail, they may need surgery to remove part or all of the nail to prevent further complications.