Ingrown toenail (and ingrown toenail surgery) at Leicester Hospital

What is an ingrown toenail?

An ingrown toenail happens when the edge of a nail curves and pushes into the skin beside it, most commonly on the big toe, though it can affect any toe.

What causes an ingrown toenail?

A number of things can lead to an ingrown toenail, including:

• cutting toenails too short, or rounding the edges rather than trimming straight across
• shoes or socks that pinch, or otherwise don't fit as they should
• an inherited tendency for nails to curve rather than lie flat
• an injury to the toe, such as stubbing it, or repeated pressure from activities like running
• nail problems, such as a fungal infection.

Symptoms typically include pain, redness and swelling around the affected nail. If it becomes infected, you might also notice pus, an unpleasant smell, or feel hot or shivery.

What are the benefits of treating an ingrown toenail?

Treating an ingrown toenail relieves pain and helps stop an infection developing or getting worse. On rare occasions, particularly for those managing diabetes or a circulation condition, an infected ingrown toenail left untreated can lead to much more serious complications, which is part of why it's worth getting checked rather than ignored.

Are there different treatment options for an ingrown toenail?

Options range depending on how severe the problem is:

• home care, suited to milder cases where there’s no sign of infection
• a GP appointment, where infection can be checked for and antibiotics prescribed if needed
• treatment from a podiatrist (foot specialist), who might cut away the ingrown section of nail, or remove the nail entirely
• nail surgery for nails that keep growing back, using a chemical called phenol on the nail bed to stop that section regrowing permanently.

What can I try before seeing a doctor?

For a mild ingrown toenail without signs of infection, it's worth trying a few things first:

• try a warm foot bath with salt dissolved in it, which softens the skin and lowers the chance of infection
• dry your foot thoroughly afterwards and keep it dry right through until evening
• switch to roomier, softer shoes or sandals for a while
• a dose of paracetamol or ibuprofen can take the edge off the pain.

Leave the toenail itself alone rather than cutting it, resist picking at your toe, and skip anything tight or pointed in the shoe department, since all of these tend to make things worse rather than better.

See a GP if home care isn't helping, your toe becomes very painful or swollen with pus, you develop a high temperature or feel unwell, or you have diabetes, since foot complications tend to carry more weight when that's part of the picture.

What happens during treatment?

A GP will check for infection and can prescribe antibiotics if needed. If the toenail is badly ingrown, a podiatrist appointment might follow on from that.

A podiatrist might cut away just the offending sliver pressing into the skin, or remove the whole nail, using a local anaesthetic injection to numb the toe beforehand if it's needed.

For a nail that repeatedly becomes ingrown, phenol may be applied to the nail bed once the problem section has been removed, stopping that part of the nail from growing back in future.

What does recovery look like?

A simple dressing is usually applied after the procedure. Most people find they have little pain afterwards and are able to return to their normal routine the following day, though it's worth keeping the area clean and dry while it heals.

You are medically and legally prohibited from driving while wearing a bulky post-operative foot dressing or a specialized open-toed surgical shoe. The thickness of the bandage severely dulls your pedal feedback and restricts emergency braking reflexes. Return to the road only once the bulky dressing is removed, you can wear a standard closed shoe comfortably, and you can forcefully stamp your foot down to execute an emergency stop without any pain or hesitation.

If you're given antibiotics, complete the full course even once your symptoms improve. Full healing can take a few weeks, so comfortable, roomy shoes during this time make a real difference.

What are the risks and complications?

Possible risks linked to an ingrown toenail, or its treatment, include:

• infection at the site, particularly if it isn’t kept clean and dry while healing
• the same part of the nail becoming ingrown again, sometimes needing a further procedure with phenol to prevent it recurring
• on rare occasions, more serious complications can occur for people managing diabetes or circulation problems.