Aftercare and Follow-up for Ingrown Toenail
Proper aftercare and follow-up for ingrown toenails should include warm antiseptic soaks, topical antimicrobials, appropriate nail trimming techniques, and regular reassessment to prevent recurrence and complications. 1
Immediate Post-Treatment Care
- Implement warm antiseptic soaks with dilute vinegar (50:50 dilution) or povidone-iodine for 10-15 minutes twice daily to reduce inflammation and prevent infection 1
- Apply topical 2% povidone-iodine twice daily to the affected area to maintain antisepsis 1, 2
- Use mid to high-potency topical steroid ointment to nail folds twice daily to reduce inflammation and pain 1, 3
- For infected ingrown toenails, oral antibiotics should be selected based on likely pathogens, with cephalexin as first-line therapy 1
- If initial antibiotic treatment fails, consider switching to sulfamethoxazole-trimethoprim for broader coverage including MRSA 1
Wound Care and Monitoring
- Monitor for signs of worsening infection such as increasing pain, redness, swelling, or purulent discharge 2
- Reassess the affected toe after 2 weeks of treatment to evaluate healing progress 2, 1
- Be vigilant for secondary bacterial or mycological superinfections which are present in up to 25% of cases 2, 1
- If pyogenic granuloma (excess tissue) forms, consider silver nitrate application or referral for removal 1
- For severe cases with no improvement after 2 weeks, consider referral to podiatry or dermatology for specialized care 1
Prevention of Recurrence
- Educate patients to trim toenails straight across, not too short or rounded at the corners 2
- File nail surfaces with an emery board after softening the nails by soaking in warm water 2
- Avoid tight-fitting shoes and wear comfortable footwear that accommodates the shape of the feet 2, 1
- Apply emollients to cuticles and periungual tissues daily to maintain skin health 2, 1
- Avoid repeated friction, trauma, and excessive pressure to the affected toe 2, 1
Special Considerations
- For diabetic patients, more frequent follow-up is essential due to increased risk of complications 2
- Patients with diabetes should examine their feet daily and rapidly contact a healthcare professional if they notice any (pre-)ulcerative lesions 2
- For recurrent, severe, or treatment-refractory cases, consider intralesional corticosteroid injections 1
- If conservative measures fail, surgical options include partial nail avulsion with or without phenolization 4, 3
- Be aware that surgical site infections, though rare, can lead to serious complications including gangrene in extreme cases 5
Long-term Management
- Schedule regular follow-up appointments for patients with risk factors for recurrence 1
- Consider gutter splinting with a plastic tube placed on the lateral edge of the nail for immediate pain relief in recurrent cases 1, 3
- For patients with persistent nail thickening, daily to weekly application of a urea-based cream can help reduce nail thickness 2
- Educate patients about proper foot hygiene and the importance of wearing clean, dry socks 4, 3
- For patients with hyperhidrosis (excessive sweating), address this condition as it can contribute to ingrown toenail recurrence 4, 3