Ingrown toenail - Nail and Distal Digit
Alerts and Notices
Synopsis
Lateral ingrown toenails are the most common type, especially in children and young adults. The nail becomes embedded into one or both lateral nail folds, with a nail spicule that breaks the epidermis of the lateral groove with subsequent inflammatory reaction and pain. Cutting the spicule aggravates the condition by causing a new, more proximal spicule to form. In time, granulation tissue may develop with concomitant oozing, bleeding, and secondary infection. The condition may be precipitated by improper nail cutting, plantar hyperhidrosis, trauma, and anatomical foot abnormalities.
The second, and much less common, type of ingrown toenail occurs distally. Normally, there is a natural counter pressure from the nail plate to the underlying tissue. Nail plate avulsion or traumatic nail shedding cause a loss of counter pressure, causing a bulbous extremity. The newly formed nail abuts this distal wall, which interferes with its normal growth. A deep transversal horn fills the distal groove and results in the ingrown nail and pain.
Codes
ICD10CM:L60.0 – Ingrowing nail
SNOMEDCT:
400200009 – Ingrown toenail
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Lobular capillary hemangioma (pyogenic granuloma)
- Paronychia (chronic, acute)
- Bowen disease
- Pincer nail
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:04/09/2017
Last Updated:02/14/2022
Last Updated:02/14/2022
Patient Information for Ingrown toenail - Nail and Distal Digit
Overview
An ingrown toenail has grown into the skin around the nail instead of over the skin. This usually happens on the sides of the nail, and it can happen on both sides or on one side. The area becomes red, swollen, painful, and sometimes infected. This happens most often on the big toe.Who’s At Risk
Ingrown toenails are often caused by cutting the toenail too short or at a crooked angle. They can also be caused by wearing shoes that are too small. Stubbing your toe, or any toe injury, can lead to an ingrown toenail.People with diabetes can have poor blood flow in their feet. Anyone with diabetes, vascular problems, or numbness in the toes should watch carefully for ingrown toenails and treat them immediately, always looking for signs of infection such as radiating redness or heat, leaking pus, a sore that doesn't heal, or a fever.
Signs & Symptoms
The upper corner of the toenail grows into the skin. This makes the skin red and swollen. Ingrown toenails can be painful.Self-Care Guidelines
Soak foot in warm water several times a day to reduce swelling and tenderness.Insert dental floss under the nail after soaking. This will encourage the nail to grow over the skin.
Use an over-the-counter antibiotic cream like Neosporin.
If possible, wear sandals until the toe is healed. Then wear supportive, well-fitting shoes. Use protective shoes if your job could result in foot injury.
Don't trim toenails too closely to the pink part of the nails. Cut straight across.
If you have a medical condition (such as diabetes) that restricts blood flow or sensation in your feet, check them daily for problems.
When to Seek Medical Care
Visit your physician if your ingrown toenail does not heal after trying the steps above, or if it comes back soon after healing. See a doctor right away if your foot shows any signs of infection, such as:- Radiating redness and/or heat
- Leaking pus
- A sore that doesn't heal
- Fever
Treatments
Your doctor may physically lift the nail from the skin, placing a divider such as cotton between the nail edge and your flesh. You'll be instructed to replace the dressing daily.If the nail is grown far into the flesh, it may need to be partially removed. Your physician will numb your toe before cutting the nail.
For an ingrown toenail that keeps coming back despite treatment, your doctor may recommend minor surgery. Part of the nail and nail bed will be removed so that it won't keep growing back.
Ingrown toenail - Nail and Distal Digit