How to fix an ingrown toenail permanently [Podiatrist Tips!]

What are the causes of an infected ingrown toenail?

When the nail pierces the skin, it becomes prone to infections. The warm, moist, and dark condition around toes provides an optimal environment for the growth of bacteria and fungi.

The infected area usually appears warm, swollen, painful,  red, and tender. The most common invading organisms include:

1-Bacteria: Staphylococcus and Pseudomonas species.

2-Fungi: Dermatophytes, Candida, Trichophyton.

• What are the Risk factors for ingrown toenails
• Athletes
• People with Foot or toe deformities such as bunions, flat foot, hammertoes, etc
• Congenital foot deformities
• Obesity
• Diabetes
• Hyperhidrosis( excessive sweating of feet)
• Systemic problems including Heart, Kidney, Thyroid, which causes fluid accumulation in the feet
• Arthritis
• Fungal infection of toes
• Edema of lower extremities
• Poor hygiene
• Bone or soft-tissue tumor of toes

How is an ingrown toenail diagnosed?

Diagnosis of an ingrown toenail is simple and is entirely based upon clinical findings.

• No labs or images are usually required, although if there is an extensive infection, an x-ray may be needed.
• Proper diagnosis requires taking into account, patient’s history and finding out the causative factors.
• If the ingrown toenail becomes infected, the doctor may order an X-ray to check the extent of nail ingrowth or any injury.
• To avoid complications, the treatment should be started as soon as possible, especially in diabetics or patients with poor peripheral circulation.

What are the Treatment options available for an ingrown toenail?

How to fix an ingrown toenail at home?

Most non-infected ingrown toenails are not a  serious medical problem and improve within a week after proper home care without causing permanent damage. Some of these remedies include:

• Soaking feet in warm water: Soak feet 3 to 4 times daily for about 15-20 minutes and then dry feet thoroughly. Epsom salt can also be added. It softens the skin around the toes and aids in stopping the nail ingrowth, ease pain and reduce swelling.
• Soaking feet in Apple Cider Vinegar: Apple cider vinegar is believed to have antiseptic, anti-inflammatory, and pain-relieving abilities. Soak feet in warm water mixed with 1/4^th cup of apple cider vinegar for about 15 to 20 minutes and dry thoroughly after soaking
• How to fix an ingrown toenail with dental floss: After soaking feet in warm water, carefully roll back the ingrown part of the nail and slip a small piece of waxed dental floss under the ingrown nail to lift the offending edge of the nail from the skin.  Change it daily or as needed until the swelling of the underlying skin decreases.
• How to fix ingrown toenail with cotton: After soaking feet in warm water, carefully roll back the ingrown part of the nail and slip a small piece of cotton dipped in olive or clove oil under the ingrown nail to lift the offending edge of the nail from the skin. 
• Change it regularly daily until the pain decreases..

According to the American College of Foot and Ankle Surgeons, cotton under the toenail can cause infection by harboring bacteria. To avoid it, cotton can be soaked in alcohol before application.

• Keep your foot dry for the rest of the day.
• Gently massage the foot and toe to improve blood circulation, which may speed up the healing process.
• Use a toe protector: Toe protectors are rings that fit around the affected area or coverings around the entire toe, providing a cushioning barrier for ingrown toenails. Some also come with medicated gel aiding in softening toenails for easy trimming.
• Use a toe brace: Toe braces are made up of thin, adhesive, and composite material. They are glued to the top of the toe and help shield the skin and lift the nail edges as it grows.
• Maintain good foot hygiene
• Cutting the nails: When the toenail grows out, cut it straight across, mimicking the curving line of the toe tip, and don’t round the edges.
• Wear comfortable wide shoes to limit pressure on the toenails, such as sandals, flip flops, or open-toed shoes. Avoid wearing tight shoes and socks. Avoid wearing heels
• Don’t cut or pick at your toenail.
• For Pain relief, use over-the-counter medicines like paracetamol/ibuprofen or try a numbing cream or spray.
• Prophylactic application of Topical antibiotics: like polysporin, Neosporin, etc. Apply bandage on toenail afterward.

If no improvement is seen within 3 to 4 days or the condition worsens, seek medical help.

When to see your podiatrist for an ingrown toenail?

• If the toenail becomes infected. Signs of infection include:
  • Fever
  • Pain
  • Swelling
  • Pus
  • foul smell
• Persistent ingrowth
• Recurring ingrowth

Or you have co-morbid like:

• Diabetes
• Poor blood circulation
• Numbness of toes
• Weak immune system

What kind of doctor treats ingrown toenails?

Doctors including podiatrists, family physicians, pediatricians, or dermatologists can treat ingrown toenails.

But podiatrists are uniquely qualified among all the medical professionals to treat this problem and are equipped with all the essential tools to treat this condition.

Ingrown Toenail Hospital Treatment

Medical:

The medical term for an infected toenail is Paronychia. If the infection remains untreated, it may lead to chronic pain, disfigurement, cellulitis, or bone infection. Depending upon the condition your doctor may suggest:

• Antibiotics: Oral or topical antibiotics to treat infections such as ampicillin, amoxicillin, and vancomycin.
• Antifungals: If the doctor finds out that ingrown nail is due to fungus, he may prescribe anti-fungal treatment.
• Lift the nail: if the problem is mild and there’s no pus, the doctor can also put a splint under the ingrown nail to lift the nail and relieve pressure, setting the nail in a new position to help it grow above the skin.

Ingrown Toenail Surgery:

If the ingrown toenail is persistent or recurrent, a doctor or podiatrist may recommend surgery.

1-Temporary resection

2-Permanent elimination/matrixectomy

Non-permanent partial toenail avulsion:

A part of the nail is removed from the nail edge to the nail base to prevent ingrowth called partial toenail avulsion.

The doctor will cut the edges of toenails to make them narrow. Folds of skin on either side of the toenail may also be removed. Afterward, the doctor may apply a phenol or laser to the nail matrix to prevent nail regrowth.

The patient is awake, and the area is numbed with local anesthesia. In some cases, this procedure may also be performed under general anesthesia. Most people return to daily activities within 2 days to a week.

After the procedure, the exposed nail bed is treated with topical antibiotic ointment and covered with a bandage.

As the nail starts growing, the doctor can place a piece of cotton dipped in alcohol under the nail to stop it from digging into the skin again, and it is to be changed daily.

This procedure is 98% effective in preventing future ingrown toenails

Total Removal of toenail:

If an ingrown nail is chronic/recurring, thickened, or distorted, the doctor may remove a part or whole of the nail or permanently destroy the nail matrix(the part where the nail grows).

This permanent ingrown toenail procedure is performed under local anesthetic so to avoid nail regrowth.

This procedure is called matrixectomy.

What are the Post-surgical Protocols to be followed?

• Cleanse the wound or soak in warm water. Add antibacterial soap or Epsom salt. Dry thoroughly.
• A topical antibiotic is applied on the toe after soaking and wrap a bandage around the toe. The dressing is to be changed daily.
• Keep the foot raised for the next 1 to 2 days.
• For 1 to 2 weeks, wear soft and wide shoes or open-toed sandals
• Avoid movements.

The doctor may advise follow-up to check whether the wound is healing properly or not.

How the nail appears after surgery?

• Nail regrows to its original size and appearance if the nail matrix isn’t removed or cauterized.
• If permanent resection is done and a large part of the nail is removed, the new nail will appear narrower on the affected border. Otherwise, there is no significant change in the new nail appearance.
• When Toenail is partially removed, it usually grows back in a few months, while it will take 1 year if the total nail, including the nail matrix, is removed.

Is permanent ingrown toenail surgery essential?

• If conservative treatment doesn’t show improvement, Surgery is recommended.
• If the condition is recurrent, chronic, and increases nail thickness, Matrixectomy becomes necessary to remove the offending part of the nail.

What are the potential complications of surgery?

Complications are rare, but they can occur if post-surgical protocols are not properly followed. These are:

• Infection
• Pain
• Tenderness
• Slow wound healing and recurrence in diabetics

• What is the cost for ingrown toenail removal?
• Ingrown toenail treatment typically costs around 50$ for at-home treatment
• If a procedure is involved, then it can cost around $200-$1000

• Ingrown toenails in babies:

Ingrown toenails are common among all age groups and gender. Because the baby nails are soft and rapid growth,  pressure by shoes, socks or toenail injury, or even genetic predisposition can lead to ingrown toenails.

• In babies, ingrown nails can occur in all toes, especially the big toes.

Sign and symptoms:

1. Non-infected:

• Babies may also pick at the offending toe resulting in pain, and the baby might cry or whimper on touching the affected area while walking or putting on the shoes.
• Swelling
• Fluid accumulation

2. Infected:

• If there’s any discharge, the ingrown nail is likely to be infected, and associated symptoms include fever, pain, swelling, and redness. Seek medical help immediately

Treatment:

• Home remedies for non-infected ingrown toenails:
  1. Soak the foot in warm water for 15-20 mins twice daily. Dry thoroughly afterward
  2. Apply over-the-counter antibiotic cream to prevent the ingrown toenail from getting infected.
  3. Gentle Massage of the area: outwards at the ingrown toenail. Massage increases circulation and improves healing.  Try to bend the nail corner upwards gently.
  4. Wear loose-fitting shoes and socks to avoid pressure on toenails while they grow
  5. As the baby’s nails start growing, Trim nails straight across and avoid curving the corners.
• If the wound becomes infected or home remedies don’t help within a week, seek immediate medical help from a podiatrist or a pediatrician.

• What are the Complications of an ingrown toenail?

If ingrown toenail remains untreated, the following complications can occur:

• Localized Toenail infection (paronychia) which may progress to:
• Deeper toenail infection of soft-tissue (cellulitis) which in turn progress to:
• Bone infection(osteomyelitis)
• Thickened and deformed toenails
• Bleeding
• Open sores
• Foot ulcers
• Loss of circulation to infected area and
• Rarely Gangrene and limb loss/amputation

If you suffer from

• Diabetes
• Poor circulation/Peripheral Vascular diseases
• Numbness of toes/ peripheral nephropathy
• Genetic predisposition to ingrown toenails

Seek medical aid at the earliest as these conditions cause poor wound healing and increase the risk of complications manifolds.

• How to Prevent an ingrown toenail?
• Trim your toenails straight across.
• Avoid curving the nail edges.
• Keep toenails at a moderate length going with the curves of the toes. Avoid cutting the nails too short.
• Leave nails long enough so that the corners lie against the skin loosely.
• Keep feet dry, clean and neat all the time
• Use clippers designed specifically for toenails.
• Sanitise toenail clippers for 15 minutes in boiling water after each use.
• Wear proper-fitting shoes, socks, and tights.
• Avoid too small or too tight shoes
• Wear low-heeled shoes to avoid pressure on toes
• Move around carefully to avoid trauma or pressure to toenails
• Wear protective foot-wears such as steel toe boots if you work in hazardous conditions to avoid toenail injuries and trauma.
• If your toenails are abnormally curved or thick, surgery may be necessary to prevent ingrown nails.
• If you have poor foot biomechanics that put excess pressure on nails, use corrective orthotic devices.
• If you have diabetes or suffering from diabetic nephropathy, peripheries are often numb, and there’s loss of pressure or pain sensation. Check feet daily for signs of ingrown toenails or other foot problems.

• What is the prognosis for an ingrown toenail?

The prognosis for an ingrown toenail is excellent if treated earlier by a health care professional who carefully addresses the risk factors when home remedies fail to resolve the issue within a week.