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Toenail - Ingrown

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Definition

  • 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.
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When To Call

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
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Care Advice

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

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Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2024. Schmitt Pediatric Guidelines LLC.
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