From the Guidelines
The treatment for an ingrown toenail involves both home remedies and medical interventions depending on severity, with the primary goal of reducing morbidity, mortality, and improving quality of life. For mild cases, start by soaking the affected foot in warm water with Epsom salt for 15-20 minutes, 3-4 times daily to reduce inflammation and pain 1. After soaking, gently lift the ingrown edge of the nail using a clean cotton swab or dental floss, then place a small piece of cotton or dental floss under the nail edge to redirect its growth. Over-the-counter pain relievers like acetaminophen or ibuprofen can help manage discomfort. Apply antibiotic ointment such as Neosporin to prevent infection and wear open-toed shoes or sandals to reduce pressure. Some key points to consider in the treatment of ingrown toenails include:
- Providing appropriate treatment for any pre-ulcerative lesion or excess callus on the foot, for ingrown toe nails, and for fungal infections on the foot, to help prevent a foot ulcer in a person with diabetes who is at risk of foot ulceration (IWGDF risk 1–3) 1
- Considering digital flexor tendon tenotomy for treating ingrown toenails and to help prevent a first or recurrent foot ulcer in a person with diabetes at risk of foot ulceration (IWGDF risk 1–3) and a non-rigid hammertoe with nail changes, excess callus or a pre-ulcerative lesion on the apex or distal part of this toe 1 If these measures fail or if you notice increasing pain, redness, warmth, drainage, or spreading infection, seek medical attention. A healthcare provider may perform partial nail removal (partial onychectomy) under local anesthesia, or in recurring cases, permanently remove a portion of the nail and nail matrix using a procedure called phenolization. People with diabetes, peripheral vascular disease, or immunocompromised conditions should seek medical care promptly rather than attempting home treatment due to increased risk of complications 1.
From the Research
Treatment Options for Ingrown Toenails
The treatment for an ingrown toenail can be divided into conservative and surgical approaches.
- Conservative treatment approaches include:
- Soaking the foot in warm, soapy water 2
- 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, managing hyperhidrosis and onychomycosis, and applying a mid- to high-potency topical steroid 3
- Surgical approaches include:
- Partial nail avulsion or complete nail excision with or without phenolization 2
- Electrocautery, radiofrequency, and carbon dioxide laser ablation of the nail matrix 2
- Matrixectomy, which can be performed through surgical, chemical, or electrosurgical means 3
- Phenolisation of the lateral matrix horn, which is now considered the safest and most commonly performed method with the lowest recurrence rate 4
Prevention of Recurrence
Preventing recurrence is a crucial aspect of ingrown toenail treatment.
- Teaching the patient the correct way to trim toenails is the most important step in preventing recurrence 5
- 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