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    Toenail- Ingrown

    Updated at March 29th, 2023

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    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

    Copyright 2000-2020 Schmitt Pediatric Guidelines LLC