From the Guidelines
Management of an ingrown toenail begins with conservative measures for mild cases, including warm water soaks 3-4 times daily for 15-20 minutes, gentle lifting of the nail edge with clean cotton or dental floss, wearing open-toed shoes or sandals, and taking over-the-counter pain relievers like acetaminophen or ibuprofen as needed. The goal of treatment is to reduce morbidity, mortality, and improve quality of life by alleviating pain, preventing infection, and promoting healing. For mild cases, prevention strategies such as proper nail trimming (straight across, not curved), wearing properly fitting shoes with adequate toe room, and maintaining good foot hygiene are essential 1. If infection is present, indicated by increased pain, redness, swelling, or discharge, antibiotics such as cephalexin 500mg four times daily for 7-10 days may be necessary 1. Key considerations in management include:
- Gentle skin care instructions given to prevent further irritation
- Avoiding repeated friction and trauma/excessive pressure
- Use of antimicrobial soaps and washing with cleansers and water
- Daily application of topical emollients to cuticles and periungual tissues For moderate to severe cases or recurrent problems, partial nail avulsion with phenolization is the recommended procedure, which involves removing the ingrown portion of the nail and applying phenol to prevent regrowth. This procedure has a high success rate with low recurrence, and is particularly recommended for cases where there is significant pain, discharge, or nail plate separation 1. Patients with diabetes or peripheral vascular disease should seek professional care promptly rather than attempting self-treatment due to increased risk of complications. Overall, the management of onychocryptosis should prioritize prevention of infection, promotion of healing, and minimization of morbidity and mortality.
From the Research
Management of Onychocryptosis (Ingrown Toenail)
The management of onychocryptosis, also known as 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 through surgical, chemical, or electrosurgical means 3, 4
- Various surgical techniques such as the Winograd technique, Vandenbos procedure, and toenail paronychium flap 4
Postoperative Complications
Postoperative complications of surgical management of ingrown toenail can include:
- Recurrences 3, 5
- Surgical site infections 2, 5
- Gangrene complicating a surgical site infection, although this is rare 5
Treatment Outcomes
The choice of treatment approach depends on the severity and recurrence of the ingrown toenail.