Toenail - Ingrown

• The corner of the toenail grows into the skin around it
• Almost always involves the big toe (great toe)

Symptoms of an Ingrown Toenail

• Toe pain from sharp corner of toenail cutting into surrounding skin.
• Redness and swelling around the corner of the toenail is usually present.
• The area may drain pus or yellow fluid.
• The red area is very tender to touch or pressure from a shoe.
• Some teens with an ingrown toenail can barely walk.

Cause of an Ingrown Toenail

• The toenail is usually pushed into the skin by wearing tight shoes.
• The tiny cut made by the nail allows bacteria to enter the skin. The cut then becomes infected.
• The sharp corner of buried nail keeps growing. The deeper it goes, the more painful it becomes.

Call 911 Now

• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Spreading red area or streak with fever
• Spreading red area or streak that's very large
• Severe pain not improved 2 hours after pain medicine and antibiotic ointment
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Spreading red area or streak, but no fever
• Entire toe is red and swollen
• Pus pocket (yellow or green) seen in skin around toenail or under toenail. Reason: needs to be drained.
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Can't locate and free up corner of toenail
• After using Care Advice more than 2 days, pus discharge not gone
• After using Care Advice more than 3 days, still hard to walk
• After using Care Advice more than 7 days, not improved
• After using Care Advice more than 14 days, not gone
• Ingrown toenails are a frequent problem
• You have other questions or concerns

Self Care at Home

• Minor ingrown toenail

Care Advice for Ingrown Toenail

What You Should Know About Ingrown Toenails:

• Ingrown toenails are always painful.
• Pain is caused by the sharp toenail edge cutting into the skin around it.
• The pain can be stopped. Find the toenail corner and lift it out of the raw tissue.
• This will allow the area to heal.
• Most ingrown toenails can be treated at home. Surgery or nail removal is rarely needed.
• Here is some care advice that should help.

Warm Soaks:

• Soak the toe in warm water and soap for 20 minutes twice a day.
• While soaking, massage the swollen part of the cuticle (skin next to the nail). Massage away from the nail.
• While soaking, also try to bend the corners of the toenail upward. Use your fingernail to lift it.
• Dry the toe and foot completely.

Elevate Corner of Toenail with Dental Floss:

• Goal: to help the toenail corner grow over the cuticle, rather than into it.
• The area won't heal until you expose the corner.
• Often you can lift it with your fingernail.
• If not, take a short strip of dental floss or fishing line. Try to slip it under the corner of the nail. Then, lift the nail upward. Cut off any sharp edge.
• Take a small wedge of cotton from a cotton ball. Try to place the wedge under the nail corner to keep it elevated. Sometimes this step is impossible.
• Elevate the corner away from the cuticle with every soak.

Antibiotic Ointment:

• After each soak, use an antibiotic ointment (such as Polysporin). Put it on the swollen part of the toe.
• You can buy this ointment without a prescription.

Taking Pressure Off Toenail with a Foam Pad or Cotton Ball:

• Until it heals, try to wear sandals or go barefoot.
• When your child must wear closed shoes protect the ingrown toenail as follows:
• Inner Edge of Toe. If the inner edge of the big toe is involved, try this technique. Tape a cotton ball or foam pad between the lower part of the first and second toes. This will keep the upper toes from touching.
• Outer Edge of Toe. If the outer edge is involved, use a cotton ball. Tape it to the outside of the lower toe.
• This will keep the toenail from touching the side of the shoe.
• Weather-stripping from a hardware store makes the best foam pad. Reason: has adhesive on one side.
• Never wear tight, narrow, or pointed shoes.

Pain Medicine:

• To help with the pain, give an acetaminophen product (such as Tylenol).
• Another choice is an ibuprofen product (such as Advil).
• Use as needed.

Prevention - Nail Trimming:

• Cut your child's toenails straight across so you can see the corners. Use a nail clipper.
• Do not round off corners. Keep the corners visible.
• Do not cut them too short.
• After baths or showers, the nails are soft. Bend the corners of the toenails upward.

Prevention - Wear Shoes That Fit:

• Make sure that your child's shoes are not too narrow. Give away any pointed or tight shoes.
• Tight narrow shoes are the most common cause of ingrown toenails.
• Shoes should have a wide toe box. The toes should not feel cramped.

What to Expect:

• With treatment, the pus should be gone in 48 hours.
• Pain should be gone in 1 week.
• Area should be healed up in 2 weeks.

Call Your Doctor If:

• Spreading redness or fever occur
• Pus pocket occurs
• Not improved after 7 days
• You think your child needs to be seen
• Your child becomes worse