Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. 

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Am Fam Physician. 2002;65(12):2557-2558

What is an ingrown toenail?

An ingrown toenail occurs when the nail edge is damaged, and the nail no longer fits properly into the side groove. The nail curls downward and digs into the skin, causing pain, swelling, redness, and drainage. Sometimes a piece of nail (called a lateral pointing spicule) becomes embedded in the side tissue, and the tissue becomes heaped up (hypertrophied).

What causes an ingrown toenail?

There are many causes for ingrown nails, but the two most common causes are poorly fitting shoes and improperly trimmed nails. Tight shoes compress the side of the nail and alter the fit of the nail in the groove. When nails are peeled off or torn, the edge of the nail can extend down into the corner of the nail groove. A torn nail can irritate the skin next to the nail, producing inflammation (swelling, pain, and redness) and sometimes infection.

Can ingrown nails be prevented?

Proper trimming of the nails is the best way to prevent an ingrown nail. Nails should be cut straight across, with the corners of the nail protruding from the end of the toe. Children or teenagers who play with their toes in bed at night can wear socks to bed to keep them from peeling or picking at their toenails.

How can I treat my painful nail?

When an ingrown toenail is mildly inflamed (slightly red and sore), soaking the foot in warm water and placing a piece of dry cotton under the corner of the nail may be all that is needed. If the ingrown toenail gets worse, the inflammation (pain, swelling, and drainage) may increase. An antibiotic ointment can be tried at this stage. After you see your doctor for the problem, he or she may try oral antibiotics. Surgical removal of part of the nail is often needed if the problem becomes worse.

What is the recommended surgical procedure for ingrown nails?

Surgical removal of an ingrown nail involves removing a small portion of the side of the nail and destroying the nail bed beneath. The toe is injected with a numbing medicine, and the toenail is cut to create a new, straight nail edge. The cells underneath the nail will try to grow a new nail, so they must be destroyed, thereby creating a permanently thinner nail. If there is heaped up (hypertrophied) tissue on the side of the toe, it must be removed. The toe is then bandaged until it completely heals (a few weeks).

What is the recovery time from my surgery?

You should keep your foot elevated for a few hours and rest on the day of the surgery; the next day, you can return to work or school. You should refrain from running or vigorous exercise for 2 weeks after the surgery.

Following Ingrown Toenail Removal

  1. Antibiotic ointment will be applied to the toe immediately after the procedure. The ointment is soothing and helps the toe to heal faster. You should apply the antibiotic ointment twice daily until the wound is completely healed. We like the over-the-counter (nonprescription) antibiotic ointment Mycitracin Plus because of the numbing medication mixed in with the antibiotic.

  2. You may shower the day after the surgery. Gently dry the area and apply antibiotic ointment after showering. Avoid baths, swimming, or soaking the toe for the next 2 weeks. Try to keep the toe clean and dry.

  3. Your bandage will help to pad and protect the wound, while absorbing drainage from the wound. You can replace the bandage if blood or fluid soaks the bandage. Please keep the wound bandaged for at least 1 week after the surgery.

  4. You may experience some pain after the procedure. If you experience discomfort, you can take ibuprofen (brand names: Advil, Motrin, Nuprin), three 200-mg tablets 3 times a day with food, and acetaminophen (brand name: Tylenol), two 325-mg tablets every 4 hours.

  5. You should wear loose-fitting shoes or sneakers for the first 2 weeks after the procedure. Please avoid wearing high-heeled or tight-fitting shoes in the future. You should avoid running, jumping, or strenuous activity for 2 weeks after the surgery. Teenagers should not participate in physical education activities for 1 to 2 weeks after the procedure.

  6. Infection may develop in the toe during the first few weeks after the surgery. Call your doctor if you develop increasing pain, swelling, redness, or drainage from the toe.

  7. Trimming the nails straight across the top of the nail is the best way to prevent another ingrown nail from developing. The nail must not be cut down into the corners, or picked at, or torn off. If you should develop another ingrown nail, see your doctor early, because early treatment may prevent the need for surgery.

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Copyright © 2002 by the American Academy of Family Physicians.

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