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    Treating Ingrown Toenails

    Christi Pagett, MD, Family Medicine Deaconess Clinic - West 09/14/2023
    Ingrown toenails are something I see in my practice fairly commonly.  Per Cleveland Clinic, 2 out of every 10 patients who see their provider for a foot issue go in for ingrown toenails.  According to Up To Date, the prevalence has been estimated to be between 2.5 % and 5% and twice more common in males than females.  The National Institute of Health reports that incidence peaks in adolescence and young adults.  Although ingrown nails can occur on the fingers, it occurs much more commonly on the toes, especially the big toe.  While sometimes it is necessary to see your healthcare provider, such in the case of infection, there are some things you can do at home to prevent and treat an ingrown toenail.    
    First let’s talk about how people get ingrown toenails.  Improper nail trimming is felt to be one of the leading causes of ingrown toenails.  Some people mistakenly try to round the corners of the nail.  When trimming toenails, it is important to cut the nail straight across.  Ill-fitting shoes can also lead to ingrown toenails.  If your shoes are too tight, the pressure can cause your nail to dig into the soft tissue, which can cause inflammation, pain, and sometimes secondary infection.  Repetitive trauma, such as during sports, can also cause ingrown toenails.  Although less common, foot deformities and certain medications can cause ingrown toenails as well.
    There is a spectrum of signs and symptoms of ingrown toenail.  Usually when the nail starts to inflame the nail fold, there can be mild redness and swelling of the nail fold.  This can also be tender with pressure.  As the inflammation worsens, there can be more swelling, tenderness, redness.  Sometimes there can be drainage, and the toe can become infected.  This is when it is important to see a doctor, especially if you have diabetes, nerve damage, or blood flow issues. 
    So what can you do at home?  It starts with prevention – as mentioned above, I recommend cutting the nail straight across, without rounding the corners.  This is best done after taking a shower/bath so the nail is soft.  If the skin becomes inflamed, you may soak the foot in warm water with soap or Epsom salt for 10-20 minutes twice a day.  You can use a steroid cream on the inflamed skin (as long as it’s not infected) to reduce inflammation.  You can also use a piece of cotton to pack the area between the offending nail edge and the underlying soft tissue, or use a piece of tape to pull the soft tissue away from the offending nail edge. 
    If these steps are ineffective, or if the ingrown toenail and symptoms are severe, it may be best to seek professional help.  Your healthcare provider may take a culture and/or start antibiotics.   Sometimes the nail (or at least part of it) needs to be removed.  Your doctor may try to make this permanent.  While ingrown toenails can be bothersome, they are treatable. 
    And now, I’ll leave you with this bit of humor:   How does the astronaut cut his toenails?    Eclipse it. 
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