Definition

• The corner of the toenail grows into the skin around it
• Almost always involves the big toe (great toe)

Health Information

Symptoms

• Toe pain from sharp corner of toenail cutting into surrounding skin.
• Redness and swelling around the corner of the toenail is usually present.
• The area may drain pus or yellow fluid.
• The red area is very tender to touch or pressure from a shoe.
• Some teens with ingrown toenail can barely walk.

Cause

• The toenail is usually pushed into the skin by wearing tight shoes.
• The tiny cut made by the nail allows bacteria to enter the skin. The cut then becomes infected.
• The sharp corner of buried nail keeps growing. The deeper it goes, the more painful it becomes.

Care Advice

1. Overview
   • Ingrown toenails are always painful.
   • Pain is caused by the sharp toenail edge cutting into the skin around it.
   • The pain can be stopped. Find the toenail corner and lift it out of the raw tissue.
   • This will allow the area to heal.
   • Most ingrown toenails can be treated at home. Surgery or nail removal is rarely needed.
   • Here is some care advice that should help.
2. Clean Area:
   • Soak the toe in warm water and soap for 20 minutes twice a day.
   • While soaking, massage the swollen part of the cuticle (skin next to the nail). Massage away from the nail.
   • While soaking, also try to bend the corners of the toenail upward. Use your fingernail to lift it.
   • Dry the toe and foot completely.
3. Elevate Corner of Toenail with Dental Floss:
   • Goal: To help the toenail corner grow over the cuticle, rather than into it.
   • The area won't heal until you expose the corner.
   • Often you can lift it with your fingernail.
   • If not, take a short strip of dental floss or fishing line. Try to slip it under the corner of the nail. Then, lift the nail upward. Cut off any sharp edge.
   • Elevate the corner away from the cuticle with every soak.
4. Antibiotic Ointment:
   • After each soak, put an antibiotic ointment on the swollen part of the toe.
   • You can buy this ointment without a prescription.
5. Taking Pressure Off Toenail With a Foam Pad or Cotton Ball:
   • Until it heals, try to wear sandals or go barefoot.
   • When your child must wear closed shoes protect the ingrown toenail as follows:
   • If the INNER edge of the big toe is involved, try this technique. Tape a foam pad or cotton ball between the lower part of the first and second toes. Your goal is to keep the upper toes from touching.
   • If the OUTER edge is involved, do the same. Tape it to the outside of the lower toe.
   • Goal: keep the toenail from touching the side of the shoe.
   • Weather-stripping from a hardware store makes the best foam pad. Reason: has adhesive on one side.
   • Never wear tight, narrow, or pointed shoes.
6. Prevention - Nail Trimming:
   • Cut your child’s toenails straight across so you can see the corners. Use a nail clipper.
   • Do not round off corners (keep the corners visible).
   • Do not cut them too short.
   • After baths or showers, the nails are soft. Bend the corners of the toenails upward. Use your fingernail to lift it.
7. Prevention - Wear Shoes That Fit:
   • Make sure that your child’s shoes are not too narrow. Give away any pointed or tight shoes.
   • Tight narrow shoes are the most common cause of ingrown toenails.
   • Shoes should have a wide toe box. The toes should not feel cramped.
8. What to Expect:
   • With treatment, the pus should be gone in 48 hours.
   • Pain should be gone in 1 week.
   • Area should be healed up in 2 weeks.

Call Your Doctor If

• Spreading redness or fever occur
• Pus not gone after 48 hours
• Not improved after 7 days
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

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