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Ingrown toenails

An ingrown toenail is a painful condition of the toe. It occurs when a sharp corner of the toenail digs into the skin at the end of or side of the toe. Pain and inflammation at the spot where the nail curls into the skin occurs first.

Photo of ingrown toenail on big toe

Ingrown toenail image credit Dr P. Marazzi / Photo Researchers, Inc

  • If left untreated, an ingrown toenail can progress to an infection, or even an abscess that requires surgical treatment.
  • Ingrown toenails are common in adults but uncommon in children and infants. Any toenail can become ingrown, but the condition is usually found in the big toe.

Ingrown toenail causes

Tight-fitting shoes or high heels cause the toes to be compressed together and pressures the nail to grow abnormally.

  • Incorrect trimming of toenails can cause the corners of the nail to dig into the skin. Nails should be trimmed straight across, not rounded.
  • Disorders such as fungal infections of the nail can cause a thickened or widened toenail to develop.
  • Injury near the nail may cause an ingrown toenail.
  • If a member of your family has an ingrown toenail, then you are more likely to develop one too.

Ingrown toenail symptoms

Ingrown toenail is a common disorder that most often affects the outer edge of the big toe. However the nail on any toe, or the nail on both sides of a toe, can become ingrown. The most common signs and symptoms are pain, redness and swelling of the skin adjacent to the corner of a toenail.

  • Early in the course of an ingrown toenail the end of the toe becomes reddened and painful with mild swelling. There is no pus or drainage. It may feel warm to the touch, but you may not have a fever.
  • Once an infection has developed the swelling will become worse, and there may be white or yellow coloured drainage from the area. A lighter coloured area of the skin may be surrounded by red skin. You may develop a fever, although this is unusual.

When to seek medical care

Any time an ingrown toenail has developed into an infection - drainage, a fever, lighter skin surrounded by red skin, or worsening pain and swelling - seek medical advice.

Even if the ingrown toenail is only inflamed without infection, seek medical advice if the following conditions also occur:

  • If you have incomplete primary immunisation for tetanus or have not had your booster tetanus immunisations, then you need to discuss your tetanus status.
  • If there is no improvement after three days of home care.
  • If you have diabetes, have poor circulation, have HIV/AIDS, are having chemotherapy or have another reason for poor healing or increased risk of infection.

Examinations and tests

The doctor will decide if an infection is present or not and how intensively to treat it.

  • The doctor will evaluate your ingrown toenail by asking how the problem developed (if any injury, when it started) and about other medical problems, medication taken, allergies and most recent tetanus immunisation.
  • A physical examination will include checking temperature, pulse and blood pressure, a detailed examination of the foot, toenail and the lymph nodes in the groin, and possibly an X-ray of the foot.
  • Blood tests may be performed if you have a severe infection or a history of diabetes.

WebMD Medical Reference

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