Ingrown toenail – what to do?

Walking in shoes can become a pain if you have an ingrown nail on your big toe. Because with every step, the toenail presses into the skin. This can cause severe pain, especially if inflammation is in the affected area. But how does an ingrown toenail occur? What can you do about it, what home remedies are there, and when can an operation become necessary? You can find answers to these questions and more information here.

What is an ingrown toenail?

An ingrown nail (Latin: Unguis incarnatus) can develop on all fingers and toes. The big toe is most commonly affected. A painful injury occurs if the nail grows into the skin at a corner of the nail, which borders it on the side. This can become inflamed over time, making the pain even worse.

 

Symptoms: what does an ingrown nail look like?

Ingrowing toenails don’t happen overnight. The symptoms usually develop slowly and insidiously over several weeks. If a toenail is ingrown, the affected area of ​​skin is usually noticeable through the following symptoms:

• Pains
• overheat
• redness
• swelling

When pressure is applied to the nail, for example, when walking in tight shoes, the pain intensifies.

If the inflammation progresses, the ingrown nail sometimes bleeds, weeps, or pus forms. New, proliferating tissue called “wild flesh” or granulation tissue can also form on the side of the nail.

Causes: How Do You Get An Ingrown Toenail?

The ingrown toenail occurs when the nail presses into the skin of the lateral nail bed and continues to grow. Certain conditions favour toenail ingrowth. These include, for example, the following causes:

• improper trimming of toenails (trimmed too short or rounded, or with lateral spur left)
• Improper footwear, especially tight shoes that put pressure on the toes
• heavy, sweaty feet because the moisture makes the skin more sensitive to injuries
• specific forms of nail growth, for example, curved or tube-like nails, which naturally press into the nail wall
• Diseases such as diabetes, kidney or heart disease or obesity
• At older age, when foot care becomes difficult due to limited mobility or thick nails

 

Ingrown Toenail: Stage Determines Treatment

The longer an ingrown toenail goes undetected or treated, the more discomfort it can cause. There are three degrees of severity, so-called stages:

• Stage 1: In the first stage, the nail has grown into the skin surrounding it on the side. There is pain and inflammation.
• Stage 2: New tissue forms on the side of the nail, the wild flesh. This can bleed, weep and ooze.
• Stage 3: The inflammation is permanent, and pus keeps coming out. The wild flesh partially grows over the nail.

Depending on the severity of the symptoms, you can either treat an ingrown toenail yourself or you should seek medical podiatry or medical help.

Treating an ingrown nail yourself

If the ingrown toenail is in early stage 1, when new tissue has not yet formed, it is possible to treat it yourself with various home remedies.

To do this, the foot should be soaked in warm, soapy water, preferably with curd soap, for ten to twenty minutes daily. After the footbath, it is essential to dry the foot thoroughly. Now, gently push the soft skin away from the ingrown nail.

The inflamed area can then be treated with a disinfecting (antiseptic) or anti-inflammatory ointment, such as Zugsalbe and iodine. However, removing large pieces of skin or parts of the nail itself is not recommended.

After the treatment, care must be taken to wear loose-fitting, open or light shoes that leave enough space for the ingrown nail and do not press on the wound.

Special aids that are suitable for self-use are also available in pharmacies. These include nail patches or a toenail clip. The clip aims to straighten the nail so it can grow straight out. An ingrown toenail can also heal on its own.

Ingrown toenail: medical foot care

Medical foot care (podology) is the right place for mild to moderate complaints if you feel unsafe or cannot or do not want to treat yourself. There are several options available to those affected to treat an ingrown toenail. The podiatrist can take the following measures, among others:

• cut the toenail properly
• place narrow strips of sterile pads between the edge of the nail and the skin
• tape the nail in such a way that the plaster pulls the inflamed area of ​​skin away from the edge of the nail
• attach a plastic splint that creates a gap between the nail and the nail wall
• put on a nail clip

The nail or nail correction brace (orthorexia brace) is individually adjusted to the toenail and hooked or glued at the edges. It is intended to lift the nail slightly on the sides and thus help to alleviate the symptoms. With the braces, the growth of the nail can be corrected slowly so that it no longer grows at the sides.

However, nail correction braces and plastic splints, in particular, are unsuitable for all those affected – for example, if there is an increased risk of foot problems due to diabetes. Medical advice should, therefore, be sought before using these aids.

 

Ingrown toenail: when to see a doctor and which doctor?

If the inflammation is stubborn and cannot be controlled by personal or podiatric treatment, a doctor’s visit is required. This is also recommended, for example, if the ingrown nail is severely inflamed and suppurating. Because then there is a risk that the infection will spread to the entire nail and the nail bed with the nail fold and nail wall ( inflammation of the nail bed ).

In such a case, an operation may be necessary. The procedure is usually performed under local anaesthesia. The following surgical techniques are possible:

• Emmert plastic (nail wedge excision): The ingrown nail edge is cut back in a wedge shape at the inflamed area.
• Extended Emmert plastic: A nail wedge is cut out here. In addition, all of the adjacent skin and part of the nail bed in the inflamed area are removed.
• Complete Toenail Removal: This surgery is rarely required. The inflammation subsides quickly after the nail is removed, and the new toenail can grow back.

 An ingrown nail can be dangerous for people with a weakened immune system . If bacteria get into the wound, the inflammation can spread to the entire toe and beyond. Such a skin infection is called phlegmosis. It is often associated with fever and fatigue. Urgent medical attention should be sought if these symptoms are associated with an ingrown toenail.

The first point of contact can be the family doctor’s practice, but a dermatologist or foot surgeon can also carry out the treatment.

Preventing an ingrown toenail

It is best to take care of your feet and toenails so that an ingrown toenail cannot occur in the first place. These tips can help prevent an ingrown nail:

1. Perform nail trimming after showering or bathing when skin and nails are soft. Alternatively, before cutting your toenails, you can take a foot bath for ten minutes to prepare your feet for care.
2. The toenails, especially on the big toe, should be cut straight and not too short (not shorter than the lateral nail bed). Be careful not to leave a thorn in the corners.
3. Visit a medical foot care regularly. This is especially true for people with an increased risk of foot problems, such as the elderly or people with diabetes.
4. Apply cream to your feet daily to keep the skin supple.
5. Wear comfortable or open-toe shoes that don’t put pressure on your toes.