This Little Piggy Cried OUCH!

Submitterd by: Dr Rebecca Wise

With warm weather comes flip-flops and sandals, but many folks are embarrassed by the appearance of their feet. Dry skin, toenail discoloration, or even the length and shape of the toes are all causes for concern for some people and the reason they don’t allow themselves to wear open-toed shoes in public. However, a more painful problem, but one that can be easily prevented is ingrown toenails. This is one of the most common reasons for visits to podiatrists (foot doctors) each year, but a few simple steps can keep your toes from being a pain in the foot!
Toenails, especially on the first or “big” toe are curved at the borders where they grow out of the skin. If this is trimmed too close, it can irritate the surrounding tissue, and even “dig in” to the flesh. This causes redness, pain, swelling, and local warmth. If it breaks the skin, it can even cause a local site infection leading to drainage or pus, and a foul odor.


Some people, however, (like those with diabetic neuropathy) don’t feel the pain or discomfort of an ingrown toenail, so the feet should be regularly inspected for redness or swelling around the nails, especially if there is an injury (like stubbing your toe) or your shoes are too tight. If you can’t inspect your feet yourself, ask a loved one or caregiver to help you.

Causes of Ingrown Toenails:

1. Heredity – the natural shape of your toes and toenails is a major factor in whether you will commonly experience ingrown nails.
2. Trauma – dropping something on the toe, kicking something, stubbing the toe, or wearing ill-fitting shoes can all cause damage to the nail, resulting in it becoming ingrown.
3. Diseases or Conditions – nail fungus, loss of a nail, or neuropathy can all lead to changes in shape of the nail as it grows out of the nail bed.
4. Trimming – Improper trimming of the shape or length of the nail can lead to injury. The nail should be cut straight across, at a length that allows the straight edges to be exposed.

Treating ingrown nails:

At home, if you have a medical condition that affects your feet (like diabetes), you should visit your podiatrist and follow his or her advice. Otherwise, you can soak your feet in room-temperature water with some Epsom salt) for about 15 minutes a day for a week or two, and gently massage the side of the nail bed after soaking to reduce any swelling or redness. Do not try to just repeatedly cut the nail shorter or to a different shape because it will only make it worse.

NEVER try to “dig it out” of the nail bed or put anything under the nail (cotton, toothpicks, etc.) because this will expose the tissue to infection or cause further damage. You may use an over-the-counter pain topical reliever but this will not correct the underlying problem.

If it’s not better in two weeks or if it gets intolerable, you should consult your physician. He may give you an antibiotic or perform a minor surgical procedure to remove part of the nail border. But if you have recurrent ingrown nails, the podiatrist may even decide to remove part of the nail root to prevent the border from growing where it does. If left untreated, ingrown toenails can lead to hypergranulation tissue (“proud flesh”) at the nail folds which requires medical care.

Don't forget the sunscreen!
Don’t forget the sunscreen!

Finally, when you do wear sandals this summer, don’t forget to apply sunscreen first so that the exposed bits don’t get burned. Also, give them a rest by removing your shoes and elevating your feet for at least 10 minutes each day to reduce stress on your feet and circulatory system.

So the best advice I can give you is: take care of your little piggys and put your feet up while the weather is warm and the sun is shining!

For further reading, please see the following:
3. Clincial Review-The management of ingrowing toenails, BMJ2012;344doi

Be Well, Be Wise,


Dr. Rebecca Wise

Wise Words…. is a general medical information column from Dr Rebecca Wise. Dr. Wise has a master’s degree in education as well as her doctorate in pharmacy. She is an assistant professor and ambulatory care specialist at a Medication Therapy Management (MTM) clinic in Erie, PA.

Soon to be released is Dr Becky’s new website which will address women’s issues, watch for it:

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