What is the treatment for an ingrown toenail?

Ingrown Toenail Treatment

For ingrown toenails, treatment should begin with conservative measures for mild to moderate cases, while surgical intervention with partial nail avulsion plus phenolization is recommended for severe or recurrent cases due to superior outcomes in preventing recurrence. 1, 2

Conservative Management (Mild to Moderate Cases)

• Soak the affected toe in warm, soapy water or dilute antiseptic solution (such as 2% povidone-iodine) for 10-15 minutes twice daily to reduce inflammation and prevent infection 3, 1
• After soaking, place cotton wisps or dental floss under the ingrown lateral nail edge to separate the nail from the lateral fold, providing immediate pain relief 1, 2
• Apply mid- to high-potency topical steroid ointment to the affected nail fold twice daily to reduce inflammation 3, 1
• Correct inappropriate footwear - wear comfortable, well-fitting shoes with adequate toe box space to reduce pressure on the toenail 4, 1
• Trim toenails straight across (not too short and not rounded at corners) to prevent recurrence 4, 3
• Consider gutter splinting (placing a small tube along the ingrown edge) to separate the nail from the lateral fold for immediate pain relief 1, 2
• For suspected fungal infection contributing to the ingrown nail, obtain cultures and consider appropriate antifungal therapy 4, 3

Surgical Management (Moderate to Severe Cases)

• Partial nail avulsion of the lateral edge combined with matricectomy (destruction of the nail matrix) is the most effective approach for preventing recurrence 1, 2
• Matricectomy can be performed through several methods:
  • Chemical matricectomy with phenol (most common and effective) 2, 5
  • Surgical excision of the nail matrix 2
  • Electrocautery, radiofrequency, or carbon dioxide laser ablation of the nail matrix 6, 2
• Partial nail avulsion with phenolization is more effective at preventing recurrence than surgical excision alone, though it carries a slightly increased risk of postoperative infection 2
• For diabetic patients at risk of foot ulceration with ingrown toenails, appropriate treatment should be provided by a trained healthcare professional to prevent complications 4

Post-Procedure Care

• Continue antiseptic soaks with dilute vinegar (50:50 dilution) or 2% povidone-iodine for 10-15 minutes twice daily 3
• Apply mid to high potency topical steroid ointment to nail folds twice daily to reduce inflammation 3
• Monitor for signs of infection (increased pain, redness, swelling, purulent discharge) which would require culture and appropriate antibiotic therapy 3, 7
• Avoid trauma to the affected digit and wear protective gloves during activities that involve water exposure or chemicals 4, 3
• Regular follow-up at 2 weeks post-procedure to assess wound healing and determine if additional interventions are needed 3

Prevention of Recurrence

• Educate patients on proper nail care: trim nails straight across, not too short, and avoid rounding the corners 4, 3
• Wear appropriate footwear that accommodates the shape of the feet and fits properly 4
• Avoid repeated trauma to the nail unit and excessive pressure on toes 4, 3
• Daily application of topical emollients to cuticles and periungual tissues to maintain skin barrier function 4, 3
• For patients with hyperhidrosis (excessive sweating), manage this condition as it can contribute to ingrown toenails 1

Special Considerations

• In diabetic patients, ingrown toenail treatment is particularly important as it can help prevent foot ulcers 4
• For non-rigid hammertoes with nail changes in diabetic patients, consider digital flexor tendon tenotomy or orthotic interventions to help reduce excess callus and prevent ulceration 4
• Surgical site infections, though rare, can lead to serious complications including gangrene; prompt recognition and treatment are essential 7