Ingrown toenails are treated based on the stage involved. Toenails in stage 1 can be treated with warm soaks, a cutout shoe, and by elevating the nail with a cotton swab. Symptoms usually improve after a couple of days, but may not resolve for 2 to 3 weeks. Toenails in stage 2 can be treated with warm soaks and oral antibiotics. Closed-toed shoes and hosiery should not be worn for at least 1 week. If the toenail is especially painful, a portion of the toenail may need to be removed. This is done in the office under local anesthesia. Toenails in stage 3 need to be treated with partial or full toenail removal. For recurrent instances of ingrown nails, the nail bed can be ablated. This is done by placing phenol on a cotton swab and inserting it under the cuticle remaining after the nail has been removed. The phenol kills the matrix cells that make the nail plate.
You can treat stage 1 ingrown toenails at home. Here’s how:
- Soak your feet. Do this for 15 to 20 minutes two or three times a day in warm water. Soaking reduces swelling and relieves tenderness.
- Place cotton or dental floss under your toenail. Put fresh bits of cotton or waxed dental floss under the ingrown edge after each soaking. This will help the nail eventually grow above the skin edge. Change the cotton or the floss daily until the pain and redness subside.
- Use a topical antibiotic. Apply an antibiotic ointment and bandage the tender area.
- Choose sensible footwear. Consider wearing open-toed shoes or sandals until your toe feels better.
- Take pain relievers. If there’s severe pain, take over-the-counter pain relievers, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) to relieve the pain until you can see your doctor.
- Check your feet. If you have diabetes, check your feet daily for signs of ingrown toenails or other foot problems.
Surgical options include nail avulsion or matrixectomy. Avulsion results in the temporary removal of the nail plate from its attachments to the nail matrix, nail bed, and periungual skin folds. It can be performed in a total or partial fashion either as the primary procedure or as an initial step in the treatment process. Matrixectomy results in the permanent destruction of the matrix cells, thereby ending nail plate production. The entire matrix can be destroyed (total matrixectomy), resulting in the permanent absence of a nail plate, or only that portion of the matrix producing the offending nail margin can be destroyed (partial matrixectomy), resulting in a narrower nail plate. Chemical matrixectomy is the most common method used.