From the Guidelines
The treatment for an ingrown toenail should begin with proper foot care, including washing the feet daily, drying carefully, and cutting toenails straight across, as recommended by the IWGDF guidelines 1. To manage an ingrown toenail, the following steps can be taken:
- Soak the foot in warm water with Epsom salt for 15-20 minutes several times daily to reduce pain and swelling
- Gently lift the nail edge with clean dental floss or cotton to help the nail grow out properly
- Take over-the-counter pain relievers like acetaminophen or ibuprofen as needed to manage pain
- Apply antibiotic ointment to prevent infection and wear open-toed shoes or sandals to reduce pressure on the toe For more severe cases, a healthcare provider may perform partial nail removal under local anesthesia, removing the ingrown portion of the nail 1. It is essential to note that proper nail trimming, wearing properly fitting shoes, and maintaining good foot hygiene can help prevent recurrence of ingrown toenails, as emphasized in the guidelines 1. In cases of recurrent ingrown toenails or infection, further medical evaluation and treatment, such as antibiotics, may be necessary, and a healthcare professional should be consulted for proper diagnosis and treatment 1.
From the Research
Treatment Options for Ingrown Toenail
The treatment for ingrown toenail can be divided into conservative and surgical approaches.
- Conservative treatment approaches include:
- Soaking the foot in warm, soapy water 2, 3, 4, 5
- Placing cotton wisps or dental floss under the ingrown nail edge 2, 3
- Gutter splinting with or without the placement of an acrylic nail 2
- Correcting inappropriate footwear and managing hyperhidrosis and onychomycosis 3
- Applying a mid- to high-potency topical steroid 3
- Using a cotton nail cast made from cotton and cyanoacrylate adhesive, taping the lateral nail fold, or orthonyxia 3
- Surgical approaches include:
- Partial nail avulsion or complete nail excision with or without phenolization 2, 5
- Electrocautery, radiofrequency, and carbon dioxide laser ablation of the nail matrix 2
- Matrixectomy through surgical, chemical, or electrosurgical means 3, 5, 6
- Phenolisation of the lateral matrix horn, which is considered the safest and most commonly performed method with the lowest recurrence rate 6
Effectiveness of Treatment Options
- Partial nail avulsion followed by either phenolization or direct surgical excision of the nail matrix are equally effective in the treatment of ingrown toenails 2
- Partial nail avulsion combined with phenolization is more effective at preventing symptomatic recurrence of ingrowing toenails, but has a slightly increased risk of postoperative infection 2
- Surgical approaches are superior to nonsurgical ones for preventing recurrence 3