There’s never a good time to have an ingrown toenail. But navigating spring and summer with one can be particularly difficult, with warmer weather calling for open-toe shoes and more exposure to the elements. Contact with dirt or the ocean can allow bacteria to enter the skin near an ingrown toenail, leading to infection, according to the Cleveland Clinic.
I should know: over the years, I’ve managed recurrent ingrown toenails, which occur when the edge of a nail grows into nearby skin, causing inflammation and pain. Twenty per cent of people who see a doctor for foot problems have the condition, according to the National Institute of Health.
Even though ingrown toenails are common, they can feel embarrassing. The usual response when I tell someone I have one is a wrinkled nose and the assumption that my feet look gnarly. This is not the case – typically, they just look a little red and inflamed (although if they get infected, like mine did once when I delayed seeing a doctor for over a week, that can be gross).
There are effective ways to manage the condition. Here’s what experts say.
What causes ingrown toenails
Trimming toenails incorrectly is one of the most common causes. A lot of people follow the curved line of the whites of their nails, but cutting straight across is better, says Dr Shital Sharma, DPM, a podiatrist and foot and ankle surgeon at New York Sports and Joints. The more the corners of a nail are cut, the more the nail will curl into the surrounding skin instead of lying flat, potentially causing an ingrown nail.
Cutting the nail too short or too rounded can create a jagged shard of nail. This shard can dig into skin as the nail grows. “When you’re bending over to trim your nails instead of someone trimming for you, sometimes you don’t notice you’re missing a shard of nail on the corner,” says Dr Joshua Hollinger, DPM, a podiatrist at Rothman Orthopaedics.
Tight shoes are another common cause. Narrow toe boxes apply constant pressure to the inner and outer corners of toenails, which can cause the nail to poke into skin, says Sharma.
In other cases, heredity is to blame. “I’ve seen whole families with ingrown toenails,” Hollinger says. In addition, individuals with bunions frequently have ingrown toenails, because as the big toe angles toward the second toe, it applies more pressure to the inside border of the nail. People with flat feet, fungal nails and dystrophic – or thickened – nails are also predisposed.
How to prevent ingrown toenails
An easy way to protect your toes is to let the nail grow slightly past the tip of your toe, then trim straight across without rounding the edges, says Dr Don Pelto, DPM, a podiatrist at Central Massachusetts Podiatry and author of The Healthy Living Guide to Ingrown Toenails. Trimming every three to four weeks is a good general practice, but this will vary for each individual.
Sharma recommends wearing wider footwear that gives your toes room, and avoiding pedicures, which can involve aggressively cutting the sides of your nails. If you do get a pedicure, ask for your nails to be trimmed straight across to avoid problems.
For athletes who wear cleats, note that they have a break-in period. “That’s when I see lots of ingrown toenails,” she adds. “So don’t throw away your old cleats – go back and forth between them [and] new cleats.”
If heredity is causing your issues, that’s trickier. Some people opt for a partial matrixectomy, where a doctor removes a small side portion of the nail and applies a chemical to the nail root to prevent it from growing back. This typically takes two to three weeks to heal, Hollinger says.
This procedure can be especially useful for people with recurrent ingrown toenails, like me. Last spring, after weeks of pain and an infection my podiatrist said was too deep in the nail root for antibiotics to treat, she performed a partial matrixectomy. I haven’t had issues since. Consult your podiatrist to discuss whether this is an appropriate measure for you.
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How to care for ingrown toenails
There are ways to care for an ingrown toenail at home. Sharma suggests soaking your foot for 15 minutes nightly in warm water with Epsom salts or table salt. “Soaking helps reduce inflammation and softens the nail so that it’s easier to trim,” Sharma says. Although it’s not a cure, you can also use a moisturizing, protective ointment such as Aquaphor to soften tough skin and nails and reduce some discomfort, she adds.
I never travel without some, in case I have a flareup. And if my toes feel sore after wearing tight shoes, such as high heels, I immediately start soaking my feet and applying Aquaphor.
Monitor your toenails as soon as you start experiencing discomfort, Sharma says. Taking pictures can be useful as the condition progresses, to construct a timeline for your healthcare provider that can help you figure out what might have triggered the problem and how quickly it’s worsening.
Take caution if you’re going swimming. “Chlorinated pools have chemicals that fight bacteria in the water, so I’m less concerned about people swimming in a pool with an ingrown toenail,” says Hollinger. “But I’ve seen nasty infections from the ocean if people swim when their skin is broken.” If you’re experiencing redness, drainage or swelling, he doesn’t recommend swimming in the ocean or a lake.
Redness and drainage are signs of possible infection, and it’s best to see a podiatrist. However, don’t wait for these symptoms to visit a doctor. “Go as soon as you notice pain and persistent discomfort when you’re walking or doing your daily routine,” Hollinger says. Sometimes a podiatrist can simply trim the offending nail to relieve the issue. But “if you wait for it to worsen, we might be limited to doing a partial matrixectomy.”
Another possible treatment is partial toenail avulsion, which removes the ingrown portion without dissolving the nail root. The nail should regrow in eight to 12 months, Hollinger says. Full toenail avulsion is rare and usually only used when both edges of the nail are ingrown, Pelto says.
Follow your podiatrist’s instruction for aftercare if they perform partial toenail avulsion or a matrixectomy. Pelto recommends daily foot soaking with Epsom salts or iodine if sterilization is required. Afterward, apply Neosporin, wear flip-flops or wide sneakers, and keep the toe wrapped in gauze or a bandage for several days, he says.
Ingrown toenails might not be the most glamorous condition, but it’s certainly a manageable one.
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Jacqueline LeKachman is a New York based-writer who covers family, sex and all the other things that keep us up at night for the Washington Post, Women’s Health, HuffPost, and more