Ingrown nails are very common, and can develop in anyone at any age. Although the big toe is usually where the symptoms develop, the other toes can sometimes be affected. Ingrown nails may be inherited genetically, and may also be seen later in life due to gradual damage to the cells under the skin that grow the nail (nail matrix). Repetitive injuries to the toe, such as heavy objects falling, pressure from poorly fitting shoes, nail fungus, or toe bruising (common in athletes) may cause irreversible changes to the nail matrix. In time, the nail may abnormally grow inward (curling down toward the skin border) due to these changes. Many people assume their cutting technique has caused a nail to grow inward. This is generally untrue, as the nail grows from the base of the skin independent of its shape at the nail tip. The shape of the nail is set long before the nail reaches the tip of the toe.

The presence of an ingrown nail does not always cause pain or irritation, as many technically ingrown nails produce no symptoms initially. However, some source of irritation, like a tight shoe, a stubbed toe, or a nail trim too close to the skin, will eventually occur and set in motion a chronic inflammation process in the skin along side the nail. The skin will become 'puffier' next to the nail, and it may begin to swell as this inflammation develops. Bacteria can become trapped underneath this skin, and eventually the well-known ingrown nail infection develops, causing redness, pain, swelling of the skin, and drainage. This process can continue in cycles for many years, as simple home treatment may relieve the infection and inflammation, but not the overall process.

Infected Ingrown Toe Nail
Infected Ingrown Toe Nail

Prevention is Difficult, but Treatment for Ingrown Nails is Possible

Ingrown nails are difficult to prevent. Properly fitting shoes can help, and cutting the nails straight across to avoid irritating the skin next to an already ingrown nail is a good way to keep inflammation down. When symptoms do develop, simple home treatment should be started consisting of regular soaking in warm, soapy water and application of antibiotic ointment. Many people also go to their family doctor at this stage for an antibiotic medication as well. While these steps can help minimize the symptoms and control the infection, they do not address the underlying cause. The offending nail border must be removed permanently to resolve the actual condition, and prevent its return. Most family practices and urgent care centers are not set up to do this procedure completely, whereas a podiatrist performs this procedure in the office daily. During the ten minute procedure, the nail border is removed under local anesthesia (leaving the rest of the nail intact) and a mild acid is applied to the nail matrix to prevent it from ever growing the nail back into the skin. Recovery is easy, requiring only a 15 minute daily soaking and the use of antibiotic ointment and band-aid dressing each day. After 2-3 weeks, most patients are fully healed. Those having this procedure done have no activity restrictions, and can bathe as usual the following day. Pain is generally minimal if present at all, and healing is usually uneventful.

When ingrown nails are ignored and no treatment rendered, the infection has the possibility of spreading up the toe, or less commonly into the bone underneath. This is especially true with diabetics and those whose immune systems are compromised. Treatment at the time the infection develops is preferred, as waiting too long could result in more serious complications and a more difficult recovery period.