When a toenail is ingrown, it is curved and grows into the skin, usually at the nail borders (the sides of the nail). This “digging in” of the nail irritates the skin with pain, redness and swelling.
If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by some drainage of fluid or even pus. However even if the toe isn’t painful, red, swollen, or warm, a nail that curves downward into the skin can progress to an infection.
Ingrown toenails can be caused by nail problems, such as fungal infections or losing a nail due to trauma.
In many people, the tendency for ingrown toenails can be inherited.
Sometimes an ingrown toenail is the result of trauma, such as banging your toe or sports that involve repeated trauma such as kicking or running.
The commonest cause of ingrown toenails is cutting your nails too short. Ingrown toenails can result from shoes that are too tight.
Pain, swelling, fluid discharge from the skin edge, redness, pain on walking and pressure from wearing shoes.
Clinical examination is sufficient.
The nature of the problem is that it is stubbornly persistent. If you start with just an ingrown toenail but no swelling etc then an infection can develop making it worse.
Proper trimming of the toenail is helpful. If an infection develops then antibiotics can treat this but may not always be successful. In persistent cases it may be necessary to seek specialist advice who may recommend a small operation under local anaesthetic to remove part or all of the toenail. This can be discussed with your surgeon. The recovery is very quick, necessitating a bandage for a few days with good recovery expected.
The operation is designed to allow the toenail to grow back straight because only part of the nail and its nail-bed (where the nail grows from) is removed. In some cases, often in the more elderly population, the whole nail-bed can be removed, in which case the nail will not re-grow.
Many patients are simply seeking advice on managing a problem. Surgery is advised if pain and disability from the toenail is a problem even after other treatments.