How to Treat Ingrown Nails: Best Practices and Medical Procedures

Introduction

Ingrown nails (onychocryptosis) are a common condition in which the edges or corners of a nail grow into the adjacent skin, often leading to discomfort, inflammation, and infection. While this condition most commonly affects the big toenails, it can occur in any nail on the hands or feet. Ingrown nails can range from mildly annoying to severely painful, and if left untreated, can lead to complications like infections and abscess formation.

Treatment for ingrown nails depends on the severity of the condition and the presence of infection. Mild cases can often be managed with conservative treatments at home, while more severe cases may require medical intervention, such as surgery. This article provides a comprehensive overview of ingrown nail treatment options, from home remedies to surgical procedures, along with prevention strategies to minimize recurrence.

By understanding the causes, symptoms, and appropriate treatments, healthcare professionals can better guide patients through the management and prevention of this common yet potentially debilitating condition.

Understanding Ingrown Nails

What Causes Ingrown Nails?

Ingrown nails occur when the nail grows into the surrounding skin, causing pain, swelling, and often infection. Several factors can contribute to the development of ingrown nails, including:

1. Improper Nail Trimming: Cutting nails too short or rounding the edges can encourage the nail to grow into the skin.
2. Tight Footwear: Shoes that are too tight can compress the toes, pushing the nails into the surrounding skin and leading to ingrown nails.
3. Injury: Trauma to the toe or repeated pressure on the nail, such as from sports activities or dropping something heavy on the foot, can cause the nail to grow abnormally.
4. Genetics: Some individuals may have nails that are naturally curved or grow downward, making them more susceptible to ingrown nails.
5. Nail Conditions: Fungal infections or thickened nails (onychomycosis) can alter nail growth and increase the risk of ingrown nails.
6. Poor Foot Hygiene: Lack of proper foot hygiene, such as not cleaning the feet regularly, can lead to debris buildup around the nails, increasing the likelihood of ingrown nails.

Symptoms of Ingrown Nails

The symptoms of ingrown nails can vary in severity, but typically include:

• Pain and tenderness along the edge of the nail, especially when pressure is applied.
• Redness and swelling around the nail.
• Infection: If the ingrown nail breaks the skin, it can lead to infection, resulting in pus, increased swelling, and warmth in the affected area.
• Bleeding in severe cases where the nail deeply penetrates the skin.
• Difficulty walking or performing daily activities due to discomfort.

Non-Surgical Ingrown Nail Treatment Options

In many cases, ingrown nails can be treated with non-invasive methods, especially if the condition is caught early and there is no infection. These treatments aim to reduce inflammation, relieve pain, and guide the nail to grow properly.

1. Warm Water Soaks

Soaking the affected foot or hand in warm water for 15–20 minutes several times a day can help reduce swelling, soften the skin, and relieve discomfort. Adding Epsom salts or an antibacterial solution like iodine can enhance the soak's effectiveness by reducing the risk of infection.

Procedure:

• Soak the affected foot in warm, soapy water or an Epsom salt solution.
• Pat the area dry and apply an antibiotic ointment to reduce the risk of infection.
• Repeat the process 2–3 times a day until the symptoms subside.

2. Antibiotic Ointments

In cases where there is mild inflammation but no visible infection, topical antibiotic creams can help prevent infection from developing. Over-the-counter products such as neomycin or bacitracin can be applied to the affected area after soaking and cleaning the toe.

Instructions:

• Apply the antibiotic ointment after soaking and drying the area.
• Cover with a sterile bandage to keep the area clean and prevent further irritation.
• Use the ointment 2–3 times daily until the nail grows out properly.

3. Lifting the Nail

If the ingrown nail is not too deeply embedded in the skin, gently lifting the nail away from the skin can help guide it to grow out normally. This is particularly effective in early-stage ingrown nails, where pain and inflammation are present but the nail has not yet penetrated the skin.

Method:

• After soaking the foot, gently lift the edge of the nail using a sterile cotton ball, dental floss, or a tweezer.
• Insert a small piece of sterile cotton or dental floss between the nail and the skin to help the nail grow above the edge of the skin.
• Replace the cotton or floss daily to maintain cleanliness and promote proper nail growth.

4. Pain Relief Medications

Over-the-counter pain relievers such as ibuprofen or acetaminophen can help reduce pain and swelling associated with ingrown nails. These medications can be taken as needed but should be used with caution to avoid masking a worsening condition.

5. Footwear Modification

For patients prone to ingrown nails or those currently suffering from mild cases, wearing properly fitting shoes with adequate toe room is essential. Tight shoes or high heels that compress the toes should be avoided, as they can exacerbate the condition.

Recommendations:

• Opt for shoes with a wide toe box to allow for more space around the toes.
• Avoid high heels or shoes that squeeze the front of the foot.
• Consider wearing open-toed shoes during treatment to reduce pressure on the affected area.

Medical and Surgical Treatment Options for Ingrown Nails

In more severe cases of ingrown nails, particularly when there is infection or significant pain, medical or surgical intervention may be required. These treatments can help remove the ingrown portion of the nail, alleviate pain, and prevent recurrence.

1. Partial Nail Removal (Partial Nail Avulsion)

When conservative treatments fail or the ingrown nail becomes infected, a healthcare provider may recommend a partial nail avulsion, a procedure in which part of the nail is removed to prevent it from growing into the skin.

Procedure:

• Local anesthesia is applied to numb the area.
• The ingrown portion of the nail is carefully trimmed or cut away using sterile surgical instruments.
• If the nail bed is inflamed or infected, the surrounding tissue may also be cleaned and treated with antibiotics.
• The remaining nail is left intact to regrow properly over time.

Partial nail removal is effective in relieving pain and preventing further complications. The patient can usually resume normal activities within a few days after the procedure.

2. Total Nail Removal (Total Nail Avulsion)

In rare cases where the entire nail is severely deformed or chronically ingrown, a total nail avulsion may be necessary. This procedure involves removing the entire nail plate, allowing a new, healthier nail to grow in its place.

When Total Nail Removal is Necessary:

• The ingrown nail is recurrent despite partial removal.
• There is significant damage to the nail plate or surrounding tissue.
• The nail has become thickened or infected beyond repair.

While total nail removal can be an effective solution, the recovery period is longer than with partial removal, and it may take several months for a new nail to fully grow.

3. Matrixectomy (Nail Matrix Removal)

For patients with recurrent ingrown nails, a matrixectomy may be performed. This procedure involves removing or destroying part of the nail matrix, the tissue that produces the nail. By doing so, the nail is prevented from growing in the problematic area, significantly reducing the risk of recurrence.

Procedure:

• Local anesthesia is applied to the affected toe or finger.
• The nail matrix is destroyed using a chemical agent (such as phenol) or by surgically removing the tissue.
• In some cases, electrocautery or laser therapy may be used to destroy the matrix.

Matrixectomy is a permanent solution for recurrent ingrown nails, but it results in a slightly narrower nail, as the removed portion will not regrow.

4. Treatment for Infections

If the ingrown nail has caused an infection, additional treatments are necessary to address the infection before or alongside other procedures. Infections may be treated with:

• Oral antibiotics: For cases of moderate to severe infection, oral antibiotics (such as amoxicillin, clindamycin, or cephalexin) may be prescribed to clear the infection.
• Drainage of abscess: If an abscess has formed, the healthcare provider may need to drain the pus and clean the area before proceeding with nail removal.

Prevention of Ingrown Nails

Preventing ingrown nails is key to avoiding recurrence and minimizing discomfort. Healthcare providers should educate patients on proper nail care and lifestyle modifications that can reduce the risk of ingrown nails.

1. Proper Nail Trimming Techniques

Nails should be trimmed straight across rather than rounded at the edges to prevent them from growing into the surrounding skin. Additionally, patients should avoid cutting nails too short, as this can increase the likelihood of ingrown nails.

Best Practices:

• Use clean, sharp nail clippers.
• Trim nails straight across, leaving a small amount of white nail visible.
• Avoid cutting nails too short, particularly at the edges.

2. Wear Appropriate Footwear

Shoes that fit well and allow plenty of room for the toes can help prevent ingrown nails, particularly for patients who are active or prone to foot conditions.

• Choose shoes with a wide toe box.
• Avoid high heels or tight shoes that squeeze the toes.
• Consider wearing sandals or open-toed shoes when recovering from an ingrown nail.

3. Maintain Foot Hygiene

Keeping the feet clean and dry can reduce the risk of infections that can exacerbate ingrown nails.

• Wash feet daily with soap and water, making sure to dry thoroughly, especially between the toes.
• Change socks regularly and wear breathable shoes to avoid moisture buildup.
• Regularly inspect nails for signs of ingrown nails and address any issues early.

4. Manage Foot Conditions

For patients with conditions that increase the risk of ingrown nails, such as diabetes, arthritis, or poor circulation, managing these conditions is essential in preventing complications. These patients should receive regular foot care and professional nail trimming if needed.

Conclusion

Ingrown nails are a common yet painful condition that can significantly affect a patient’s quality of life. Early treatment with home remedies such as warm soaks and proper nail care can often resolve mild cases, but more severe or recurrent cases may require medical intervention, such as partial nail removal or matrixectomy. By providing patients with the appropriate treatment options and preventive care, healthcare professionals can help reduce the incidence of ingrown nails and improve patient outcomes.