An ingrown toenail, medically known as onychocryptosis or unguis incarnatus is a common and painful condition of the toe. It occurs when a sharp edge of the toenail digs into the skin, pain and inflammation begin at the spot where the nail curls into the skin. Some common causes of the ingrown toenail are ill-fitting shoes, toenail fungal infection, improper nail trimming, injury, etc. Conventional methods include surgical treatment or wedge resection and matrixectomy. However, there are a few home remedies for ingrown toenail such as soaking your feet into Epsom salt, apple cider vinegar, hydrogen peroxide bandage, proper trimming, etc.

The toenail area can get severely inflamed and even infected if the condition is ignored. Ingrown toenails can occur in any age group and known to have a higher incidence rate in males.

What causes ingrown toenail?

1. Ill-fitting shoes

Tight-fitting shoes and high heels can cause the toes to be compressed together. This bundling of the toes builds up pressure on the nail making them grow abnormally.

2. Toenail fungal infection

Fungal infections such as onychomycosis of the nail can cause a thickening of nail plate which can, in turn, cause the nail to develop abnormally.

3. Improper trimming

Improper trimming of toenails is also a leading cause of ingrown toenail. Nails should not be rounded at the edges.

4. Injury

Trauma to the nail plate or toe can by dropping objects on or stubbing the toenail or during sports like soccer. Nail injury can cause the nail to grow abnormally.

5. Bunions

Pressure from abutting digits caused by hallux valgus or bunions can cause ill-fitting of the footwear which can lead to an ingrown toenail.

6. Bone condition

The presence of a subungual exostosis, an enlarging bone condition commonly seen in adolescents can lead to onychocryptosis.

7. Tumour

Bony or soft-tissue tumours of the toes can put pressure on the developing nail leading to its abnormal development.

8. Oedema

Oedema of the lower extremities can also cause an ingrown toenail.

9. Sweating

Hyperhidrosis or excessive sweating of the feet is also a predisposing factor for onychocryptosis.

10. Medication

The use of isotretinoin for the treatment of severe acne also causes ingrown toenail in certain individuals (1).

Symptoms of an ingrown toenail

  • Pain along the margins of the nail.
  • Swelling at the base of the nail on the ingrowing side.
  • Pain becomes excruciating on wearing tight footwear.
  • Sensitivity to pressure around the affected nail.
  • Bumping of an infected toe can produce sharp excruciating pain.
  • Infected toenails can have redness and swelling around the nail.
  • Drainage of pus and watery discharge tinged with blood can also occur.

What are the types of an ingrown toenail?

It is broadly classified into three categories (2).

Stage 1

The initial phase of a budding ingrown nail characterised by nail-fold swelling, erythema, oedema and pain with pressure.

Stage 2

The second stage of ingrown toenail develops further into the skin causing swelling, drainage, infection and ulceration of the nail fold.

Stage 3

If care is not taken to treat the toenail in earlier stages, it can progress and exhibit chronic inflammation and hypergranulation along the edges of the toenail.

Conventional treatment modalities

Mild to moderate ingrown toenail cases can be resolved by cutting the affected area and giving room for the nail to breathe. In extremely infected cases, surgical intervention is needed. The surgical treatment is carried out by a podiatrist (3).

Ingrown toenail surgery is typically an in-office procedure requiring local anaesthesia and can take a maximum of up to two hours. The surgical method usually applied for operating a toenail, which is also called as a wedge resection.

If in spite of doing the wedge resection, if there is a recurrence, then the nail is completely excised. This procedure is called matrixectomy (4).

Nail bracing is preferred in cases of diabetes, who cannot undergo surgery. A splint is attached at the top of the nail to prevent the ingrowth and flatten the nail bed. In some cases, the nail bracing can require a period of up to 18 months to provide the necessary and permanent changes.

How to get rid of an ingrown toenail?

1. Epsom salt soak

Soak your feet in warm water with a tablespoon of Epsom salt. The solution will help you in getting rid of swelling and associated pain with the ingrown toenail. The warm salt water will assist in clearing up the debris that tend to build up beneath the nail bed due to increased pressure.

You must soak your feet three to five times a day till the pain and inflammation subside. The nail will become soft after the soak and can be cut straight to prevent the sharp edges from protruding into the skin.

2. Apple cider vinegar soak

Apple cider vinegar has antimicrobial, anti-inflammatory properties. Add a cup of apple cider vinegar to lukewarm water. You can soak your feet into this mixture for ten to fifteen minutes.

This will prevent any bacterial infection from thriving in the affected region. It will also lessen the inflammation associated with the ingrown toenail.

3. Dental floss

Place a strand of dental floss under the nail bed of the affected toenail after soaking the nail with either of the methods mentioned above. Leave the floss overnight and keep on repeating this procedure till toenail begins to grow above the skin edge.

4. Bandage soaked with hydrogen peroxide

Hydrogen peroxide is an effective home remedy for healing an ingrown toenail. It is also a potent disinfectant which will reduce the risk of infection.(5) It also helps soften the skin, and you can trim the softened nail easily.

Alternatively, you can bandage cotton soaked in hydrogen peroxide on the affected ingrown toenail for thirty to forty minutes. The debris will come up lining the edges of the nail. Later, you can clean it with a sterile orange stick.

5. Essential oils

The essential oil has a ton of benefits on our health. One of such advantage is that it helps in reducing inflammation and pain of the ingrown toenail. You can use any essential oil such as tea tree oil, clove oil, lavender, etc. and mix its 2-3 drops in almost an ounce of carrier oil such as coconut oil and olive oil.

Massage affected with the help of this essential oil solution. You will get a lot of relief from pain and inflammation.

6. Trimming of nail

Cut a ‘V’ shape in the middle of the toenail. The nail will now begin to grow towards the centre rather than the edges. The process is slow but gradual.

How to prevent ingrown nail?

Prevention is the best method to deal with onychocryptosis.

  • Wear properly fitting shoes that allow you room to wiggle your toes.
  • Do not wear ill-fitting shoes or heels.
  • Wear sports appropriate shoes.
  • Maintain proper foot hygiene, try and remove the dust and debris collected beneath the nail beds every day.
  • Start trimming the nail straight and avoid cutting them too short or rounding the edges.
  • Dry the nails with antimicrobial powder, especially during rains.

Final words on the ingrown toenail

Do not attempt any surgical intervention at home for treating an ingrown toenail. Other than causing some permanent damage, the nail bed can get infected leading to severe complications. If the pain lasts for more than three days, visit a podiatrist and get the necessary treatment.