Toenail - Ingrown

Is this your child's symptom?

  • The corner of the toenail grows into the skin around it
  • Almost always involves the big toe (great toe)

Symptoms of an Ingrown Toenail

  • Toe pain from sharp corner of toenail cutting into surrounding skin.
  • Redness and swelling around the corner of the toenail is usually present.
  • The area may drain pus or yellow fluid.
  • The red area is very tender to touch or pressure from a shoe.
  • Some teens with an ingrown toenail can barely walk.

Cause of an Ingrown Toenail

  • The toenail is usually pushed into the skin by wearing tight shoes.
  • The tiny cut made by the nail allows bacteria to enter the skin. The cut then becomes infected.
  • The sharp corner of buried nail keeps growing. The deeper it goes, the more painful it becomes.

When to Call for Toenail - Ingrown

When to Call for Toenail - Ingrown

Call 911 Now

  • You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

  • Spreading red area or streak with fever
  • Spreading red area or streak that's very large
  • Severe pain not improved 2 hours after pain medicine and antibiotic ointment
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Spreading red area or streak, but no fever
  • Entire toe is red and swollen
  • Pus pocket (yellow or green) seen in skin around toenail or under toenail. Reason: needs to be drained.
  • You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Can't locate and free up corner of toenail
  • After using Care Advice more than 2 days, pus discharge not gone
  • After using Care Advice more than 3 days, still hard to walk
  • After using Care Advice more than 7 days, not improved
  • After using Care Advice more than 14 days, not gone
  • Ingrown toenails are a frequent problem
  • You have other questions or concerns

Self Care at Home

  • Minor ingrown toenail

Call 911 Now

  • You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

  • Spreading red area or streak with fever
  • Spreading red area or streak that's very large
  • Severe pain not improved 2 hours after pain medicine and antibiotic ointment
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Spreading red area or streak, but no fever
  • Entire toe is red and swollen
  • Pus pocket (yellow or green) seen in skin around toenail or under toenail. Reason: needs to be drained.
  • You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Can't locate and free up corner of toenail
  • After using Care Advice more than 2 days, pus discharge not gone
  • After using Care Advice more than 3 days, still hard to walk
  • After using Care Advice more than 7 days, not improved
  • After using Care Advice more than 14 days, not gone
  • Ingrown toenails are a frequent problem
  • You have other questions or concerns

Self Care at Home

  • Minor ingrown toenail

Care Advice for Ingrown Toenail

  1. What You Should Know About Ingrown Toenails:
    • Ingrown toenails are always painful.
    • Pain is caused by the sharp toenail edge cutting into the skin around it.
    • The pain can be stopped. Find the toenail corner and lift it out of the raw tissue.
    • This will allow the area to heal.
    • Most ingrown toenails can be treated at home. Surgery or nail removal is rarely needed.
    • Here is some care advice that should help.
  2. Warm Soaks:
    • Soak the toe in warm water and soap for 20 minutes twice a day.
    • While soaking, massage the swollen part of the cuticle (skin next to the nail). Massage away from the nail.
    • While soaking, also try to bend the corners of the toenail upward.
    • Dry the toe and foot completely.
  3. Elevate Corner of Toenail with Dental Floss:
    • Goal: To help the toenail corner grow over the cuticle, rather than into it.
    • Take a short strip of dental floss or fishing line. Try to slip it under the corner of the nail. Then, lift the nail upward. Cut off any sharp edge.
    • Take a small wedge of cotton from a cotton ball. Try to place the wedge under the nail corner to keep it elevated. (Sometimes this step is impossible).
    • Elevate the corner away from the cuticle with every soak.
  4. Antibiotic Ointment:
    • After each soak, use an antibiotic ointment (such as Polysporin). Put it on the swollen part of the toe.
    • You can buy this ointment without a prescription.
  5. Taking Pressure Off Toenail With a Cotton Ball:
    • Until it heals, try to wear sandals or go barefoot.
    • When your child must wear closed shoes protect the ingrown toenail as follows:
    • Inner Edge of Toe. If the inner edge of the big toe is involved, try this technique. Tape a cotton ball or foam pad between the lower part of the first and second toes. This will keep the upper toes from touching.
    • Outer Edge of Toe. If the outer edge is involved, use a cotton ball. Tape it to the outside of the lower toe.
    • This will keep the toenail from touching the side of the shoe.
    • Never wear tight, narrow, or pointed shoes.
  6. Pain Medicine:
    • To help with the pain, give an acetaminophen product (such as Tylenol).
    • Another choice is an ibuprofen product (such as Advil).
    • Use as needed.
  7. Prevention - Nail Trimming:
    • Cut your child's toenails straight across so you can see the corners. Use a nail clipper.
    • Do not round off corners. Keep the corners visible.
    • Do not cut them too short.
    • After baths or showers, the nails are soft. Bend the corners of the toenails upward.
  8. Prevention - Wear Shoes That Fit:
    • Make sure that your child's shoes are not too narrow. Give away any pointed or tight shoes.
    • Tight narrow shoes are the most common cause of ingrown toenails.
    • Shoes should have a wide toe box. The toes should not feel cramped.
  9. What to Expect:
    • With treatment, the pus should be gone in 48 hours.
    • Pain should be gone in 1 week.
    • Area should be healed up in 2 weeks.
  10. Call Your Doctor If:
    • Spreading redness or fever occur
    • Pus pocket occurs
    • Not improved after 7 days
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Copyright 2000-2019 Schmitt Pediatric Guidelines LLC.

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