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Management of ingrown toenails

Beth G Goldstein, MD
Adam O Goldstein, MD, MPH
Section Editors
Robert P Dellavalle, MD, PhD, MSPH
Moise L Levy, MD
Deputy Editor
Rosamaria Corona, MD, DSc


Ingrown toenails (or onychocryptosis) occur when a spicule of the lateral nail plate pierces the lateral nail fold and penetrates into the skin, with subsequent foreign-body inflammatory reaction and secondary infection (picture 1). The great toenail is most commonly affected. Characteristic signs and symptoms include pain, edema, exudate, and granulation tissue. Predisposing factors include poorly fitting shoes, excessive trimming of the lateral nail plate, pincer nail deformity (picture 2), and trauma. The diagnosis is based upon clinical appearance and rarely is difficult.

This topic will discuss the management of ingrown toenails. Paronychia and other skin disorders are discussed separately. (See "Paronychia" and "Overview of nail disorders".)

Treatment — The treatment of ingrown toenails depends upon the severity of the lesion. All patients should be educated about proper nail trimming; the lateral nail plate should be allowed to grow well beyond the lateral nail fold before trimming horizontally. Patients should also be educated about the importance of well-fitting shoes.

Mild to moderate lesion — Mild to moderate lesions are characterized by minimal to moderate pain, little erythema, and no discharge. Two options for conservative treatment are as follows [1,2]:

Place a cotton wedging or dental floss underneath the lateral nail plate to separate the nail plate from the lateral nail fold, or use tape to pull the lateral nail fold away from a spicule [3], thereby relieving pressure. An additional option called "cotton nail cast" has been proposed for mild ingrown toenail. Without anesthesia, a piece of cotton (u-shaped), is placed with forceps between the nail plate and inflamed tissue, secured with a cyanoacrylate liquid glue, and allowed to harden to form a "cast" [4].

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Literature review current through: Nov 2017. | This topic last updated: Jun 01, 2017.
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