Ingrown Toenail: What Helps at Home, When It Needs Removing, and What It Costs

It usually starts small. The side of your big toe is sore in your shoes. A few days later it is red and puffy along the nail, and then one morning there is a bead of pus at the corner.

That is an ingrown toenail: the edge of the nail has grown into the skin beside it, and the skin has reacted. It is one of the most common foot problems doctors see, especially in teenagers and young adults, and most cases settle with simple care at home. Some do not, and for those there is a short procedure under a local anaesthetic that removes only the strip of nail causing the trouble.

What an ingrown toenail actually is

A toenail sits in a groove of skin on each side. Normally the nail edge grows forward past the end of that groove without touching it. When the corner of the nail curls down, or is cut too short, it can grow into the skin instead. The skin treats it like a splinter. It swells, it hurts, and it can become infected.

It is almost always the big toe, usually on one side.

Why it happens

The common causes are ordinary ones:

- Cutting the nail too short, or rounding off the corners. This is the most common cause. The corner grows back into the skin instead of past it.

- Tight or pointed shoes. Closed school shoes, sports shoes and formal shoes press the skin of the toe onto the nail edge.

- Sweaty feet. Skin that stays damp all day is softer and easier for a nail edge to pierce. Delhi summers, and long days in closed shoes, do not help.

- Picking or tearing the nail instead of cutting it.

- The shape of your nail. Some people have nails that curve down sharply at the sides. This tends to run in families, and it is why some people get ingrown nails again and again however carefully they cut.

- An injury, such as stubbing the toe.

Symptoms, in the words people actually use

- "The side of my toe hurts when I wear shoes"

- "It's red and swollen next to the nail"

- "There's pus coming out of the corner"

- "There's a lump of soft, red flesh growing over the nail"

- "It keeps coming back on the same toe"

The soft red lump is called granulation tissue. It is the skin trying to heal around something it cannot push out, and it is a sign the problem has been there a while.

Go to a hospital emergency department instead if…

Most ingrown toenails are a nuisance, not an emergency. These are the exceptions. They need a hospital the same day, not a clinic appointment:

- redness that is spreading beyond the toe, up the foot or the leg, or red streaks running up from it

- fever, shivering, or feeling generally unwell with a painful toe

- you have diabetes and the toe or the skin around it is turning dark, grey or black, or smells bad

- the foot is cold, pale or numb

- severe pain in a person with diabetes or poor circulation, even if the toe does not look bad

People with diabetes can have reduced feeling in their feet, so an infection can be worse than it feels.

What helps at home

If the toe is sore and a little red but there is no pus and no spreading redness, try this first:

1. Soak the foot in warm water for 10 to 20 minutes, two or three times a day. A little salt or soap in the water is fine. Then dry it well, including between the toes.

2. Wear open shoes or sandals where you can, or the widest shoes you own. Take pressure off the toe.

3. Lift the corner gently. After a soak, when the nail is soft, a small wisp of clean cotton or a short piece of dental floss can be tucked under the ingrowing corner to lift it off the skin. Change it daily. Do not force it.

4. Let the nail grow out. Do not cut it shorter.

5. For pain, take the pain medicine your doctor advises, and read the label of anything you already have at home.

What not to do

- Do not cut a V into the middle of the nail. It does not change how the edge grows.

- Do not dig the corner out with scissors, a blade or a nail file. It usually gives relief for a few days and then the nail grows back into the same place, often deeper.

- Do not ask a pedicurist to cut out the corner. Rounding off the corners is the most common cause of the problem in the first place.

When it needs a doctor

See a doctor if:

- it is not clearly getting better after a few days of the care above

- there is pus, or the soft red lump of tissue has appeared

- it keeps coming back on the same toe

- you have diabetes or poor circulation, at any stage

- you are pregnant, because that changes which treatment is used

An antibiotic on its own does not fix an ingrown toenail. It can calm an infection for a while, but while the nail edge is still in the skin, the infection tends to come back. Routine antibiotics before or after treating the nail have not been shown to help it heal. Where infection is clearly spreading, your doctor will decide whether you need one.

How removal works

If the nail needs treating, the usual procedure is a partial nail removal. It takes away only the narrow strip of nail that is growing into the skin, not the whole nail.

1. The doctor examines the toe and asks about diabetes, circulation, any medicines that thin the blood, allergies and pregnancy.

2. A local anaesthetic is injected at the base of the toe. The injection stings for a few seconds. After a few minutes the toe is numb.

3. The doctor lifts and removes the ingrowing strip of nail, from the tip back to its root.

4. Often a chemical is then applied to the root of that strip, so that it does not grow back. Your doctor will tell you whether this is right for you.

5. The toe is dressed, and you walk out.

Removing the whole nail is rarely needed and is usually not the better choice.

Does it come back? Sometimes. A Cochrane review of 24 trials found that surgery prevents the problem returning better than non-surgical treatment. In one trial that compared the same procedure with and without the chemical at the root, the nail grew back into the skin in about 1 in 7 people who had the chemical, and in about 2 in 5 who did not.

After the procedure

- Rest with the foot up for the rest of the day.

- The dressing is usually changed after a day or two. After that, short warm soaks and a fresh dressing help it heal.

- A thin, watery discharge for two to three weeks is normal, especially if a chemical was used at the root.

- Wear open or loose shoes until it has healed, usually within a few weeks.

- Call us if the redness spreads, the pain gets worse, or you develop a fever.

What we will not do

We will not remove a nail that has only just started to hurt and has not had a fair try of the simple care above. Most mild ingrown toenails settle without a procedure.

We will not treat a toe that keeps getting infected with one course of antibiotics after another without dealing with the nail edge that is causing it.

Nail removal is done at the clinic, not at home. If you need dressing changes afterwards and cannot easily come in, a nurse can do those at home.

And if your foot's circulation is poor, or you have diabetes with a foot wound, a procedure on the toe can heal badly. In that case the right place may be a hospital foot team, and we will tell you so rather than operate here.

Who does it, and what it costs

Ingrown toenail removal is done at the clinic by two of our doctors:

- Dr. Waquar Yunus, General Physician. MBBS (International Higher School of Medicine, Bishkek, 2022); FMGE qualified, December 2022; registered with the Delhi Medical Council. Junior Resident, VMMC & Safdarjung Hospital, New Delhi. Over 3 years' experience. He is at the clinic Monday to Saturday, 8:00 AM to 9:00 PM.

- Dr. Sushma Vikirna, General Physician (Maternal & Child Health). MBBS; PGDMCH (Post Graduate Diploma in Maternal and Child Health); MBA (Healthcare Administration). 40 years' experience, including large government hospitals, CGHS and ESIC. She sees patients Monday to Saturday, 2:00 to 5:30 PM.

| | Fee |

|---|---|

| Ingrown toenail removal, at the clinic | ₹2,000 |

| Consultation — Dr. Waquar Yunus | ₹800 |

| Consultation — Dr. Sushma Vikirna | ₹1,200 |

| Dressing change, simple, at the clinic | ₹500 |

| Dressing change, simple, by a nurse at home | ₹700 |

| HbA1c (average blood sugar), if you have diabetes | ₹399 |

| Blood sample collection at home | free |

You will not need everything on this list. Many people need only the consultation and home care. When you call, tell us what the toe looks like and whether you have diabetes, and we will tell you what your total is likely to be before you come.

Frequently asked questions

Does the procedure hurt?

The local anaesthetic injection stings for a few seconds. Once the toe is numb, you should feel pressure but not pain. The toe is usually sore for a few days afterwards, and the pain medicine your doctor advises is usually enough.

Will my toenail grow back?

The rest of the nail keeps growing normally. Whether the removed strip regrows depends on whether its root was treated. A slightly narrower nail is the usual result.

Can I walk and go to work afterwards?

You will walk out of the clinic. Most people with a desk job are back at work within a day or two, in loose shoes or sandals. Leave sport, running and tight shoes until the toe has healed.

I have diabetes. Can I have it done here?

Tell us when you call. People with diabetes need their toe treated sooner, not later, and the doctor will look at your circulation, your sugar control and the toe before deciding whether to do it here or send you to a hospital foot team.

My child has an ingrown toenail. Is that common?

Yes, especially in teenagers. Tight school shoes, sports and cutting the nails too short are the usual causes, and home care works for most. Bring your child in if there is pus or it keeps coming back.

How do I stop it happening again?

Cut your toenails straight across, not curved, and not too short — the corners should sit level with the end of the toe. Wear shoes with room for your toes, keep your feet clean and dry, and do not pick at the nails.

Book an appointment

All Is Well Medical Centre

Shop no. 1, Central Market, Sector B Rd, opposite Vasant Square Mall, Masoodpur, Sector B, Vasant Kunj, New Delhi, Delhi 110070

Phone: 8800844793

WhatsApp: https://wa.me/918800844793

Book an appointment: https://alliswellmedicalcentre.com/doctors-appointments

Open Monday to Saturday, 8:00 AM to 9:00 PM. Closed Sunday.

Call and we will give you a time. If the toe is very painful or has pus, say so on the phone and we will find you the earliest slot.

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Medically reviewed by Dr. Sushma Vikirna, MBBS, PGDMCH, MBA (Healthcare Administration), General Physician, 40 years' experience.

This article is general information and is not a substitute for a consultation. If you are unwell, please see a doctor.

Contact

Call 8800844793. Home nursing 6 am to midnight

Phone

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