Gain foothold over ingrown toenail

Q: I have a red, painful area on my big toe, near the edge of the toenail. I assume it's an ingrown toenail. It has made exercising and even wearing my normal shoes quite painful.

What can I do to heal my toe and keep this from happening again?

A: It does sound like you have an ingrown toenail. This painful condition usually develops on the big toe, when a corner of the toenail curves down and digs into the skin. The symptoms may include soreness, swelling, redness and warmth. If the toenail breaks the skin, bacteria may enter and cause an infection.

There are many possible causes for your ingrown toenail. One is trauma; for example, maybe you stubbed the toe, dropped something on it or someone stepped on it. Loss of the toenail, repetitive pressure from certain sports, a fungal infection or psoriasis also could be to blame. Thick or curved toenails (nails tend to curve more with age) are particularly susceptible, and some people have an inherited tendency to develop nail problems. Improper nail trimming, such as cutting the corners of the nail, can also make ingrown toenails more likely.

Wearing shoes that are too tight, too narrow or too short raises the risk of ingrown toenails. Women's high heels are also a common source of trouble. Increased heel height transfers most of your body weight toward the front of the foot. The big toes are subjected to a lot of pressure over the years as a result of high heels, especially if you wear them consistently for a long period of time.

You can do several things at home to treat an ingrown toenail. However, if you suspect an infection, or if you have diabetes, circulation problems or numbness in the toes, skip the home remedies and see your clinician or a foot specialist immediately.

If your symptoms are minor, the toe is irritated and red but not infected, for example, and you don't have a complicating medical condition, you can start at home with conservative measures.

Soak your foot in lukewarm water two or three times a day for 15 minutes. (Count a shower as a soak). Massage the skin at the side of the toenail (the nail fold), gently pushing it away from the nail. After each soak, dry your foot thoroughly. Wear sandals or other low-heeled open-toed shoes whenever possible. When you wear close-toed shoes, make sure the toe box (the front of the shoe) allows room for the toes to move freely.

Experts recommend against trying to dig out and trim the corner of the ingrown toenail yourself. If the toenail becomes infected or isn't better after three to five days of conservative care, you should see your doctor, a podiatrist or dermatologist. The clinician may need to remove the ingrown part of the nail, and in some cases, you may need to take an oral antibiotic to control infection.

If you have recurrent ingrown toenails, more extensive nail removal may be needed. In a commonly performed procedure called a partial nail avulsion, a narrow vertical strip of nail on the affected side is cut, from the nail edge to the base of the nail, and removed.

Most people return to normal activities, wearing an open-toed shoe, a day or two after the procedure. Consult your clinician about when you can return to vigorous exercise, such as jogging or aerobics.

More often than not, ingrown toenails can be prevented. Once the current problem has been resolved, either through home treatment or with the help of a doctor, take these steps:

--Wear low-heeled shoes that provide enough room at the toes, with stockings or moisture-wicking socks that allow your toes to move freely.

--Keep your feet clean and dry.

--Use a toenail clipper to trim your toenails, not a fingernail clipper. If your toenails are especially thick, try a spring-handled tool called a toenail nipper.

--Cut your toenails across, following the slight curve of the toe. Don't round the corners down as you might a fingernail. And don't cut toenails too short. You should be able to get your fingernail under the end of the toenail.

If you are struggling with the pain and discomfort of an ingrown toenail, it's hard to put your best foot forward. By giving your toes the care and attention they deserve, you'll be back on your feet and exercising again soon.

The Harvard Medical School Adviser is researched and written by the faculty and staff of Harvard Medical School. Visit www.health.harvard.edu/adviser.