Ingrown toenails are common and occur when the toenail grows into the skin of the toe rather than over it. An ingrown toenail can become infected, as the nail can tear the skin and create an opening for bacteria to enter and infect the toe.
Ingrown toenails can be caused or exacerbated by a number of factors, including:
— Ill-fitting shoes. High heels or shoes that pinch at the toes can cause the nail to grow into the skin. Always opt for shoes that fit appropriately and provide plenty of room in the toe box.
— Genetics. For some folks, frequent ingrown toenails might be dictated by genetics. “The nails may grow thicker or just grow a certain way that then causes the corner or the border of the nail to grow into the skin,” says Dr. Lori Grant, a podiatrist and foot and ankle surgeon with Orlando Health in Florida.
— Age. “As people get older, their biomechanics can change and they might be walking on the side of the foot a little bit more,” which can encourage the toenail to become ingrown, says Dr. Marcella MacDonald, a podiatrist in private practice in Manchester, Connecticut.
— Trauma or injury. Stubbing your toe or dropping something heavy on it can cause the nail to curve inward and begin growing into the skin. Repetitive pressure on the toes, such as might occur if you’re a ballet dancer or wearing cleats for soccer or baseball, can also cause ingrown toenails to develop.
— Cutting the nails wrong. If you cut your toenails too short or at an angle, this can cause the nail to grow into the skin as it grows longer. Be conservative when trimming your toe nails, and make sure you clip them straight across. Grant recommends filing the corners to round the edge to prevent a pointy corner from growing into the skin.
— Pedicures. Grant says that while pedicures might be nice, “you have to be careful. The nail techs at the salon might cut the nail the wrong way. I’m not anti-pedicure; just use caution when getting pedicures,” she says.
Ingrown toenails can be uncomfortable and unsightly, but there are a few things you can do to relieve them with items you have in your own cupboard.
— Soaking. The first order of business in addressing an ingrown toenail is to soak in warm, soapy water for 20 minutes a couple of times a day. Just be sure to dry your feet thoroughly after soaking.
— Apple cider vinegar. Vinegar is a common disinfectant that has anti-microbial and anti-inflammatory properties, so adding some vinegar to a tub of warm water and soaking for 15 to 20 minutes can help bring down some of the swelling and redness and keep infection at bay.
— Epsom salts. Soaking the foot for about 15 or 20 minutes in a tub of warm water with a cup of Epsom salts dissolved in it can help soften the skin and nail enough for you to dislodge it from the skin to trim it and file it.
— Peroxide. Peroxide has antibacterial properties that can help combat any infection that might be present, so consider adding peroxide to the foot soak.
— Trimming and filing. If the toenail is not infected, you can gently try to pull the nail out from the skin and trim and file it to keep it clear of the area.
— Antibacterial ointment. After soaking your feet and trimming the nail carefully, apply some antibacterial or antibiotic ointment to prevent the toe from becoming infected.
— Over-the-counter pain relievers. Anti-inflammatories such as acetaminophen or ibuprofen can help take the pain out of an ingrown toenail and may help reduce the swelling and redness.
— Toe braces or toe protectors. A toe brace or toe protector is a cushion barrier that prevents an ingrown toenail from rubbing against the inside of your shoe and getting further infected and ingrown. You can find them in the foot care aisle of your local pharmacy.
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When to See a Doctor
If your ingrown toenail has become infected, it’s time to see your general practitioner or a podiatrist. “If there’s redness and swelling or drainage” of pus, that means it’s time to see a doctor, “because those are signs that it’s becoming infected and usually you need an antibiotic at that point,” Grant says.
“Don’t wait until it gets red and oozing pus,” MacDonald says. “When it starts getting pink and its tender to the touch, find a podiatrist.” She also notes that “you don’t have to go to the emergency room for an ingrown toenail.” Rather, your primary care provider or a podiatrist can usually take care of this common problem during a normal office visit.
If you have a tendency to get ingrown toenails frequently, your podiatrist may recommend an in-office procedure to correct the problem. “There’s a permanent procedure that we can do where you can permanently remove the border of the toenail that keeps in-growing,” Grant says. Your doctor will numb the area and cut out the problematic part of the toenail. An acid is applied to prevent the nail from growing back. Full recovery takes about two weeks, but it’s an easy procedure that can be done right in the doctor’s office and takes about 10 minutes.
To prevent ingrown toenails in the future:
— Keep the skin softer by soaking regularly and moisturizing the skin.
— Keep your feet dry.
— Wear comfortable shoes and socks that leave plenty of room for the toes.
— Trim your nails straight across, but not too short and round the edges with a file.
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A Word About Diabetes and Other Conditions
Though having diabetes is not specifically a risk factor for ingrown toenails, if you have diabetes, you’ll need to take extra care to look out for ingrown toe nails. “You need to check your feet, check your feet and be careful with what you do with your feet,” Grant says. “Come in sooner than later,” if you have diabetes and develop an ingrown toenail. “Don’t wait for it to become red and swollen.”
Foot maintenance can be difficult for people with diabetes, because the disease can cause peripheral neuropathy that makes it more difficult to know when the foot has been injured.
” Preventive care is really important” for people with diabetes, MacDonald says. “I have some patients who come in with infected, ingrown toenails or other problems with their feet, and they don’t event feel it. So that’s why it’s really important to keep an eye on their feet.”
She also encourages health care professionals, particularly those working in senior living facilities, to make a point of checking out patients’ feet. “Keep an eye on things from the ankle down,” she says.
Similarly, if you’re immunocompromised, such as can occur if you’re on chemotherapy, you should also take care to inspect your feet daily to make sure there’s no infection.
And, if you’ve ever been told to cut a notch in the center of the toenail to prevent ingrown toenails, “this is a myth,” MacDonald says. “I wish it worked that way, but the nail won’t fill that gap and this is a myth.”
Grant adds, “the nails grow from the back, so physiologically, cutting a V into the nail won’t make a difference.”
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