Ingrown Toenail (Excised)

You've had an ingrown toenail removed (excised) by a doctor. An ingrown toenail occurs when the nail grows sideways into the skin next to the nail. This can cause pain and may lead to an infection with redness, swelling, and sometimes drainage.

If there's a lot of redness and swelling, you may also get an antibiotic. The redness and pain should go away within 48 hours. It will take about 2 weeks for the exposed nail bed to become dry and for the swelling to go down.

If only the side of the nail was removed, it will start to grow back in a few months. To keep an ingrown nail from coming back, sometimes the side of the nail bed may be treated with a strong chemical or lasers.

An ingrown toenail may seem more like an inconvenience than a serious problem. But if you have diabetes, poor circulation, peripheral vascular disease, or a history of foot ulcers, an ingrown toenail can lead to serious problems. If you have any of those conditions, get medical care at the first sign of an ingrown toenail.

An ingrown toenail most commonly affects teenagers and young adults. The big toe is the most common location, but other toes can become affected. The most common cause is trimming your toenails wrong. Some people trim the nails too close to the skin and try to round the nail too tightly around the shape of the toe. When you do this, the nail can grow into the skin and cause infection. It's safer to trim the nail in a straight line rather than a curve.

Other causes include injury or wearing shoes that are too short or tight. This can cause the same problem that happens when trimming your toenails. Sometimes you are born with a toenail that grows too large for your toe. It can also happen from repeated trauma to the toes, bad foot hygiene, excessive sweating, and the use of some medicines.

The most common symptoms of an ingrown toenail include:

• Pain.
• Redness.
• Swelling.
• Drainage.
• Odor.
• An ulcer on the skin near the nail.

It's important to treat an ingrown toenail as soon as you notice there's a problem. If the irritation is mild, you may be able to take care of it at home. Home care includes:

• Frequent warm water soaks.
• Keeping the nail clean.
• Wearing loose, comfortable shoes or open-toe sandals.
• Trimming the nails straight across.
• Not picking at your nails or tearing them at the corners.
• Watching your toe for any signs of infection.

Another way to help the toe heal is to use a small piece of cotton or waxed dental floss to gently lift the corner of the problem nail. Change the cotton or floss often, especially if it gets dirty.

If your infection is mild but home care isn't working, or the toenail is getting worse, see your doctor. Signs that the infection is getting worse include:

• Swelling.
• Redness.
• Pus drainage.
• Pain that's getting worse.

• Twice a day for the first 3 days, clean and soak the toe:
  • Soak your foot in a tub of warm water for 5 minutes. Or hold your toe under a faucet of warm running water for 5 minutes.
  • Clean any remaining crust away with soap and water using a cotton swab.
  • Put a small amount of antibiotic ointment on the infected area.
  • Cover with a bandage until the exposed nail bed is dry and there is no more drainage. You may ask your doctor about nonstick bandages that will not stick to the still-healing nail bed.
• Change the dressing or bandage every time you soak or clean it. Or whenever it gets wet or dirty.
• If you were prescribed antibiotics, take them as directed until they're all gone.
• While your toe is healing, wear comfortable shoes with a lot of toe room or wear open-toe sandals.
• Avoid walking barefoot.

• You can take over-the-counter medicine for pain, unless you were given a different pain medicine to use. Talk with your doctor before using these medicines if you have chronic liver or kidney disease. Also talk with your doctor if you've had a stomach ulcer or digestive tract bleeding, or you're taking blood-thinner medicines.
• If you were given antibiotics, take them until they're all gone. It's important to finish the antibiotics even if the wound looks better. This makes sure that the infection completely clears.

To prevent ingrown toenails:

• Wear shoes that fit well. Don't wear shoes that pinch the toes together.
• When you trim your toenails, don't cut them too short. Cut straight across at the top and don't round the edges.
• Don't use a sharp object to clean under your nail since this might cause an infection.
• If the toenail starts to grow into the skin again, put a small piece of cotton under that side of the nail to help it grow out straight.

Follow up as advised by your doctor. If the ingrown toenail recurs, follow up with a foot specialist (podiatrist) for treatment.

Contact your doctor right away if any of these occur:

• You notice an ingrown toenail and you have one of these conditions:
  • Diabetes
  • Poor circulation
  • A history of foot ulcers
  • Peripheral vascular disease
• Increasing redness, pain, or swelling of the toe
• Red streaks in the skin leading away from the wound
• Pus or fluid that keeps leaking for more than 24 hours
• Fever of 100.4°F (38°C) or higher, or as advised by your doctor