The following may be seen when an ingrown nail is present:

•  Redness around the toenail
• Swelling of the skin around the toenail
• Pain and tenderness in the skin along the side of the nail
• Infection. Clear yellow or purulent (pus) drainage can be a sign of infection.

There are many factors that increase a person’s risk of developing an ingrown nail, especially a toenail including:

• Improper-sized shoes, either too small or too large
• Athletics, especially those in which there is frequent stopping and starting such as tennis, soccer, and basketball
• Cutting toenails too short and/or not straight across
• Repetitive trauma or pressure to the toes and feet
• Poor foot hygiene
• Abnormally long toes
• Having unusually curved toenails
• Fungal infection of the nails
• Excessive sweating of the feet
• Diabetes
• Swelling of the legs and feet
• Abnormal gait which may occur as a result of arthritis or other illness or deformity
• Obesity

The diagnosis of an ingrown nail is generally straightforward and requires no additional testing. At one extreme, there may simply be tenderness at the edge of the nail when pressure is applied. Upon closer inspection, the nail is seen to press into the skin. As the condition progresses, there is usually redness and swelling.  When an infection occurs, there may also be drainage, pus, and foul odor.

Making the proper diagnosis may require a physician evaluation since some conditions such as tumors, foreign bodies, and fungal infections may appear to be an ingrown nail to the untrained observer. Patients who are immunocompromised, have poor circulation, or have a history of diabetes should also seek medical advice since infection may be more likely.

Many patients will self-treat ingrown nails successfully; however, it is important to seek medical care if bearing weight or walking is affected, if there are signs of an infection or if you have a compromised immune system, poor circulation or diabetes.

For mild cases of ingrown nails, soaking the toe in a dilute solution of vinegar, Epsom salts, or bleach may be helpful. Elevating the foot, taking oral anti-inflammatory medications, and avoiding shoes that apply pressure to the toe are other measures that can help.  However, if these are not successful or there is a worsening of the condition, it is necessary to see a physician.  At this point, antibiotics and surgical treatment may be needed.

Surgical treatments such as a partial nail removal will eliminate the offending portion of nail with gradual regrowth of the nail. If the condition recurs, it may be necessary to permanently remove the nail with a procedure called a matrixectomy which can be done surgically or chemically.

Outcome and Management

If left untreated, an ingrown toenail can lead to an infection of the surrounding skin and even the underlying bone. Patients with diabetes are especially at risk for this complication.

To prevent an ingrown toenail, it is important to practice the following:

• Trim toenails straight across.
• Trim toenails so they are even with the tips of your toes; if trimmed too short, the pressure from shoes may push a nail to grow into the fold around the nail.
• Wear shoes that fit properly.
• Wear protective footwear while performing tasks that may injure your toes or feet.
• Check your feet. If you have diabetes, are immunocompromised, or have decreased blood flow to your feet, check your feet daily for signs of ingrown toenails or other sores.