Ingrown Toenails

An ingrown nail is a nail that curves into the skin. The medical term is onychocryptosis. It may or may not be painful, and may or may not cause infection. An ingrown nail that becomes infected or inflamed causes paronychia along the border of the nail. Ingrown toenails that are inflamed or infected are usually very painful. The picture to the left is a mild ingrown nail with some redness and inflammation.

Common Causes

Improper Cutting or trimming of nails is the most common cause. The corners of toenails should not be rounded or “cut out” as this can lead to ingrown nails. It is best to cut the nail straight across and buff the corner to remove the sharp edge.

Trauma or any damage to the nail or the nail bed.

  • Microtrauma: Repetitive pressure from shoes. Military cadets in basic training, runners, tennis & soccer players commonly have ingrown toenails. Shoes, especially shoes that are too short or too narrow shoes place pressure on the big toenail, resulting in repetitive microtrauma.
  • Blunt trauma: Dropping something on your toe or kicking a chair.

Fungus can cause changes in the shape and thickness of the nail making trimming difficult. Improper trimming or breaking of the nail sometimes results in an ingrown nail.

Genetics: some people are born with nails which naturally turn in at the sides and typically develop ingrown nails very early in life.

Subungual Exostosis is a small bony spur that grows on the top of the bone lying just under the toenail, usually the result of trauma. With the bone pushing upward on the center of the nail, the nail becomes deformed (it peaks in the middle and the two edges are pushed downward into the skin), causing the nail to become ingrown.


Treatment Options

1. Trimming & Soaking
At the first sign of an ingrown nail, soak the nails in warm water and epsom salts (about 1/2 cup to a gallon of water) for 15 minutes twice a day.

After the nail has softened, trim the edge of the nail. (Do NOT trim down the sides of the nail, this will make the problem worse).

If you can, take a small blunt instrument and see if you can pack a very small piece of cotton along the offending nail border pushing the skin away from the nail plate. This will enable the nail to grow out normally rather than into the skin.

2. Wedge Resection

A wedge resection involves a trip to see a podiatrist.
A section of the nail is removed, without anesthetic.
For some types of ingrown nails, this will work well. But, there is a higher chance that the ingrown nail will return.

3. Antibiotics
Although antibiotics are necessary in most cases that involve infection, they will not cure the ingrowing toenail.
Antibiotics are commonly used in conjunction with nail surgery.

4. Nail removal – temporary

A partial nail avulsion is the removal of part of the nail.
This procedure involves an injection of anesthetic to numb the toe.
The nail margin is removed on one or both sides.
The nail always grows back in, but the idea is to allow the surrounding skin area to heal and inflammation to decrease before the nail grows back in.
This is a good procedure for 1st time ingrown nails, ingrown nails which started after an episode of trauma or a certain pair of shoes.
With chronic ingrown nails, there is a high recurrence rate with this procedure.

In the image to the right the section outlined is the only portion of the nail removed. The entire nail does not need to be removed if only one side of the nail is ingrown.


5. Permanent Nail Removal
This is called a matricectomy or matrix cauterization.
In most cases only the side of the nail is removed, not the entire nail.
A chemical is used to kill the nail root, called the matrix.
This procedure involves an injection of anesthetic at the base of the toe.
About 5-10 % of the time, the nail will regrow.
This treatment is best for those that have chronic ingrown nail problems and those that have deformities of the nail bed.
Individuals with very poor circulation as diagnosed by a physician, should not have this procedure performed due to the inability of the tissues to recover from the chemical burn that is induced.

The procedure is demonstrated in the diagram below. The chemical is used to destroy the nail root and prevent regrowth is placed at the base of the wound after the offending nail border is removed.


6. Subungual Exostectomy

This procedure involves surgically removing a small bone spur from the bone in the end of the toe known as the distal phalanx. The nail is removed on a temporary basis, a small incision is made along the end of the toe and the bone spur is removed. The nail will gradually grow out again and should remain flat and adhered to the nail bed, hopefully eliminating the recurrence of ingrowing nail borders.

Call Central Carolina Foot and Ankle Associates at 919-477-9333 for an appointment or click the link below.

Central Carolina Foot & Ankle Associates

2609 N. Duke Street, Ste. 301
Durham, NC 27704
(near the corner of N. Duke St. and Stadium Dr.)

5107 Southpark Drive
Suite 202
Durham, NC 27713
(close to RTP and Chapel Hill)