What is the best way to handle an ingrown toenail?

Management of Ingrown Toenails

For ingrown toenails, professional treatment with partial nail avulsion combined with phenolization is the most effective approach to prevent recurrence, though conservative measures can be attempted for mild cases first. 1

Initial Assessment and Conservative Management

For mild to moderate ingrown toenails:

• Proper nail care:

  • Cut toenails straight across rather than curved
  • File nail surfaces with an emery board after softening in warm water 1
  • Avoid improper trimming which is a common cause 2

• Conservative treatments:

  • Soak the foot in warm, soapy water
  • Place cotton wisps or dental floss under the ingrown nail edge to separate it from the lateral fold 1, 2
  • Apply mid- to high-potency topical corticosteroid ointment to reduce inflammation 1
  • Consider gutter splinting for immediate pain relief 2

• Footwear modifications:

  • Wear shoes with adequate toe box width
  • Avoid high heels and pointed shoes that compress toes 1
  • Consider protective toe caps for activities with risk of toe trauma 1

When to Escalate to Surgical Management

Surgical approaches are indicated for:

• Moderate to severe cases
• Failed conservative management
• Recurrent ingrown toenails
• Presence of infection or abscess formation

Surgical Management Options

1. Partial nail avulsion with phenolization:

   • Most effective surgical approach with lowest recurrence rates 3
   • Involves removal of the ingrown portion of nail followed by chemical destruction of the nail matrix 2

2. Alternative surgical approaches:

   • Partial nail avulsion without phenolization (higher recurrence rate)
   • Complete nail excision (more invasive but effective for severe cases)
   • Matrix ablation using electrocautery, radiofrequency, or carbon dioxide laser 3, 4

Post-Procedure Care

• Keep the area clean and dry
• Apply topical antibiotics if prescribed
• Wear open-toed shoes or sandals until healing occurs
• Follow up within 1-2 weeks to ensure proper healing 1
• Return within 48-72 hours if signs of infection develop 1

Prevention of Recurrence

• Maintain proper nail trimming technique (straight across)
• Apply urea-based cream to reduce nail thickness for patients with recurrent ingrown toenails 1
• Wear appropriate footwear with adequate toe box
• For chronic paronychia, consider daily dilute vinegar soaks (50:50 dilution) twice daily 1

Special Considerations

• Diabetic patients require more vigilant monitoring and earlier intervention due to increased infection risk 1
• Immunocompromised patients may need more aggressive treatment and lower threshold for oral antibiotics 1
• Patients with hyperhidrosis should focus on keeping feet dry and may benefit from antiperspirants

When to Seek Medical Evaluation

Medical evaluation is necessary in cases of:

• Abscess formation
• Signs of spreading infection
• Systemic symptoms (fever, malaise)
• Immunocompromised status
• Failure to improve with home treatment 1

Surgical approaches are superior to nonsurgical ones for preventing recurrence, with partial nail avulsion combined with phenolization being the most effective method despite a slightly increased risk of postoperative infection 3, 2.