How to Treat and Prevent Ingrown Toenails

Toes don’t require much maintenance, other than daily washing and drying and the occasional nail trim. When it comes to cutting your toenails, though, technique matters. Straying from conventional recommendations can cause a sharp toenail edge to grow into the soft flesh of your toe and lead to an ingrown toenail.

An ingrown toenail—usually on the big toe—is one of the most common reasons why people schedule an appointment with a podiatrist. Early on, an ingrown toenail can cause pain and inflammation. Left untreated, it can become infected.

“Patients often wait too long before seeing a podiatrist about an ingrown toenail,” said Jacob Stibelman, DPM, a Cedars-Sinai podiatrist. “They come in when the infection is pretty bad, and most of them say, ‘It’s been bothering me for a month.’”

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Taking care of an ingrown toenail early can help you avoid complications.

What Causes an Ingrown Toenail?

Some people are prone to ingrown toenails because they’re born with nails that are either too wide or curved too far downward at the edges.

“Everyone’s nails slightly curve on the side, but some are more noticeably curved and press against the skin,” Stibelman said.

The condition can run in families and affects people of all ages, from babies and children to adults. However, many people experience an ingrown toenail for the first time during adulthood, typically because of the way a nail has been trimmed.

Patients often wait too long before seeing a podiatrist about an ingrown toenail.

“They’re aggressively cutting the nail edge and leaving a sharp barb—a sharp, pointed piece of nail—that starts the process,” Stibelman said. “I also see patients who get overly aggressive pedicures. They cut too much of the nail, leaving a barb and traumatizing the tissue, which causes overgrowth and starts that cycle.”

Narrow, tight-fitting shoes can make the problem worse. Every time you take a step, it can put pressure on the toenail barb that’s digging into your skin, potentially causing more trauma to the delicate tissue around the nail.

Symptoms of an Ingrown Toenail

The first sign of an ingrown toenail is often pain, followed by inflammation, which can make your toe look red and swollen. There can be overgrowth of the surrounding skin. Over time, you may feel a constant throbbing in your toe. Wearing shoes may become uncomfortable.

Whenever you wear shoes, you’re placing your feet in a warm, moist, dark environment that bacteria love. Bacteria can infect an ingrown toenail by entering the wound where your toenail has pierced the skin. If you develop an infection, your toe may feel warmer and look redder than it did before, and there may be discharge from the wound.

“Infections can happen overnight,” Stibelman said. “It can look OK and just be a little painful one day, and the next day, it blows up with swelling, redness and even pus.”

How to Manage an Ingrown Toenail at Home

When you notice an ingrown toenail, don’t ignore it. If you have diabetes, quickly seek care from a podiatrist or your primary care doctor to prevent complications.

If your ingrown toenail is new, not terribly inflamed and not infected, you may be able to manage it at home. Try soaking your foot in warm water with Epsom salt to ease pain and relieve inflammation. Doing Epsom salt soaks two or three times daily may keep the condition from advancing.

“Conservative treatments like this try to decrease inflammation and buy time for the nail to grow,” Stibelman said. “The goal is to get the nail to grow out and then cut it straight across.”

Don’t attempt to pry an ingrown toenail out of your skin on your own. You will likely do more harm than good. Instead, see a podiatrist.

“There’s a misconception that jamming in cotton balls or using floss to lift up the nail can help,” Stibelman said. “That’s going to make things worse because you’re introducing more trauma.”

How to Prevent an Ingrown Toenail

After you have your first ingrown toenail, you won’t want another one. These simple lifestyle changes can help you keep another one from developing:

• Make a straight cut. When you trim your toenails, cut straight across. “Avoid rounding the nail too much,” Stibelman said. “Cutting your nails straight across leaves nice, square borders. If you aggressively round it, you might leave a barb.”
• Leave some white edge behind. Be conservative when you’re cutting your toenails. Don’t trim off the entire free edge. “Let it grow a little bit longer,” Stibelman said. “If you chase every white bit, you may be cutting it too short.”
• Find out your true shoe size. When shoe-shopping, people often focus solely on the length of their foot, but that alone won’t give you the proper fit. “When you get jeans, you care about two sizes: the waist and the length,” Stibelman said. “It should be the same way with shoes. Pay attention to both the length and the width. Narrow shoes can cause stress to ingrown toenails. Wear shoes that are wide enough for your foot.”
• Practice good foot hygiene. If  you have an ingrown toenail, proper hygiene may help prevent an infection. “Wash your feet and toes in the shower, then dry between the toes,” Stibelman said. “Try to keep your feet dry, and if they’ve been trapped in socks and shoes all day, let them air out at night.”

Treatment for an Ingrown Toenail

If you’re unable to manage an ingrown toenail at home, make an appointment with a podiatrist. They try to treat ingrown toenails conservatively whenever possible, recommending at-home strategies, such as Epsom salt soaks and wearing open-toed shoes, to decrease inflammation so the toenail can grow out.

For more complex cases, podiatrists use different procedures to remove the sharp toenail edge from your surrounding soft tissue.

First, a podiatrist will numb the toe with a lidocaine injection.

If the ingrown toenail is mild, a podiatrist may cut out just the offending section of toenail that’s causing damage to the toe.

“We do what’s called a wedge resection procedure, where we cut a little wedge out, smooth the corner of the nail to reset it and allow it to grow in,” Stibelman said.

For chronic ingrown toenails, or for moderate or severe infections, a podiatrist may perform a partial nail avulsion, which removes the entire nail edge on the affected side of the toe.

“We cut out the border of the nail from the tip all the way to the base,” Stibelman said. “Some of that is attached to the skin, so there will be a wound that needs to heal.”

Next, the podiatrist may perform a chemical matrixectomy. After removing the nail border, they apply phenol, an acid, at the base of the toenail to prevent the nail border from growing back in that spot.

“The nail will then be permanently thinner at that corner, so it won’t press into the skin,” Stibelman said.

Recovery after a removal procedure takes 10 to 14 days. You’ll go home with gauze and a compressive bandage on your toe. After a few days, you’ll be able to switch to an adhesive bandage with a little antibiotic ointment. You shouldn’t need oral antibiotics for an ingrown toenail unless you have a severe infection.