Carl's big toe was throbbing. He couldn't figure it out — he hadn't stubbed it recently, he hadn't even kicked a soccer ball. So why was the big toe on his left foot so red and swollen? Pretty soon an oozy-white liquid formed around the upper-right corner of his nail — he couldn't even run because the pain had gotten so bad. Carl had to see the doctor.

Turns out Carl made a mistake lots of people make — he had cut his nails too short, causing one of his big toenails to become ingrown.

Don't All Toenails Grow in the Toe?

Yes, but not all nails grow into the toe. A toenail is ingrown when one or both sides of the nail begin to break through and grow into the soft skin of the toe. This can lead to irritation and infection because of all the bacteria that hang out in and around feet.

How Did My Nail Do That?

Ingrown toenails can develop pretty quickly. The most common trigger of ingrown toenails is poor nail-trimming skills. Nails that are cut too short often allow the skin on the sides to cover the corners of the nail. This causes the nail to grow back beneath the skin. Nails that are ripped off, instead of cut, also have a tendency to become ingrown because they don't have defined corners. Nails that are rounded rather than cut straight across can also cause the nail to break the soft skin.

Other common causes of ingrown toenails include:

• Poorly fitting shoes. If the shoe doesn't fit, don't wear it. Ingrown toes are often caused by improperly fitting footwear. Shoes that are too tight can push the skin on the sides of the nail up over the nail, forcing the nail to grow in. Shoes that are too short can also cause nails to grow into the soft skin.
• Toe injuries. OK, so an ingrown toenail may seem like the least of your worries if you've ever actually dropped a bowling ball on your feet. But an injury to the toe that causes the nail to fall off can lead to ingrown nails because a new nail has a higher chance of becoming ingrown than an existing one.
• Repeated activity. Sometimes, simply repeating the same activity — like kicking a soccer ball — over and over again can lead to ingrown toenails.

Is That What I Stink, Ahem, Think It Is?

Ingrown toenails have many symptoms. But how can you tell for sure if that sore toe is ingrown or just annoying? Obviously pain is a dead giveaway, but other symptoms of an infected ingrown toe include:

• swelling around the ingrown edge
• a pink/red coloring (looks irritated)
• liquid or pus discharge
• a warm feeling

Another sign that something may be off with your toe is a foul odor. Talk about adding insult to injury.

D.I.Y. Foot Care

Ingrown toenails, if caught early, can be treated at home without ever visiting a doctor. If you notice a slight pain and see that your nail is starting to grow into the skin along the side, you can take action to relieve the pain and attempt to avoid infection. Try soaking your affected foot in warm salt water for 20 minutes at a time, 2-3 times a day, to relieve discomfort.

To prevent the nail from settling back into the skin, you can try to relieve the pressure by placing a piece of a dry cotton under the semi-ingrown corner of the nail. You can also use antibiotic cream on the irritated area — this can help prevent infection.

If the pain persists or seems to be getting worse, contact a doctor ASAP.

What's Up, Doc?

With something that seems as minor as an ingrown toenail, it may seem like overkill to visit the doctor. But once infection sets in, ingrown toenails can be very serious and almost always require medical attention.

If you start to notice any of the signs of infection, like discharge or smell, contact your doctor, who may refer you to a podiatrist (foot specialist). A podiatrist will determine what action will be taken on your nail. The most minor of surgeries is sometimes required to remove the embedded corner of the nail and to drain the pus or liquid that has built up in the skin. Not to worry, though — you won't be knocked out for the surgery but a local anesthetic will be used to numb the toe.

If the nail persists in growing into the skin, slightly more drastic measures might be required. Certain cases involve removal of a larger portion of the nail, or even the entire nail permanently. The podiatrist will decide what course of action is best for your situation.

Follow-up care after surgery is almost as important as the surgery itself. Make sure you do exactly as your doctor says after surgery to help prevent infection and recurrence of the ingrown nail.

Reviewed by: Steven Dowshen, MD
Date reviewed: May 2010