Infected ingrown toenail: What is it and how worried should I be?

An infected ingrown toenail is different than your ordinary run of the mill ingrown toenail.  Regular ingrown toenails, though painful and likely to severely impact your mobility and ability to engage in various activities, could theoretically be left alone until the pain became too unbearable.

Not so with infected ingrown toenails.  An infected ingrown toenail is far more serious and something you should be very concerned about.  If you have an infection in your toe we encourage you to seek professional consultation as soon as possible.  The key reason for this is that the infection introduces a myriad of risk factors, including death or toe amputation.

What is an infected ingrown toenail?

First of all, let’s talk about what an infected toenail really is. The toenail itself has not been infected, thus it would be more appropriate to refer to it as an infected toe or an infected toe resulting from an ingrown toenail. Be that as it may, the infected ingrown toenail speaks to the infection that occurs when the ingrown toenail digs into the skin of the toe and creates a wound that subsequently becomes infected.

Ingrown toenails have three stages. The first stage listed below describes your run-of-the-mill variety ingrown nail.  The second and third stages address infected ingrown toenails:

  • Stage 1: Redness of the skin (erythema) and swelling (edema) occurs when fluids collect under the skin in response to the pressure from the toenail. Pain is evident in the lateral nail fold.
  • Stage 2: Sufferers experience higher levels of pain and discomfort and can observe discharging of puss/fluid from the area where the nail meets the skin.  Bacterial paronychia, a nail disease characterized by red, hot skin is evident.
  • Stage 3: Left untreated, the body responds through a process called hypertrophy where skin/tissue cells in the infected area grow in size in the lateral nail wall.

What causes an infected ingrown toenail?

As we alluded to above, infected ingrown toenails and regular ingrown toenails are basically the same thing.  The only difference is that the former is in a more severe condition and serious state.  The cause of an ingrown toenail infection is the same thing that causes regular ingrown nails.

The likely culprits may be improper nail-trimming habits, genetic predisposition, or various forms of trauma (e.g. stubbing the toe, athletic trauma or workplace incidents). Another common culprit are ill-fitting shoes.  Women who wear uncomfortable, foot contorting heels for extended periods of time are very susceptible to ingrown nails.

Now the actual manifestation of the infection occurs for a variety of reasons and each person will be unique.  Many people report having ingrown toenails repeatedly and for extended durations without ever getting infections.  Others, may be more sensitive to infections due to compromised health or other factors surrounding how they deal with the ingrown nail over time.

If you have an ingrown toenail and your feet are constantly in moist, sweaty environments, you are probably far more likely to develop an infection as opposed to keeping your feet clean and dry.

Treating Infected Nails

Unfortunately, treating infected ingrown toenails is a little bit different than treating regular ingrown toenails.

Individuals suffering from ingrown toenails in  Stage 1 (above) have a variety of options at their disposal.  First and foremost, they can attempt to utilize home treatment remedies and other options so as to hopefully avoid ingrown toenail surgery.

These options include extended soaking of the feet in warm/hot tubs of water with some using epsom salt or other ingredients to form a soaking solution.  Immediate remedies also include the placing of various homemade splint devices under the toenail so as to elevate it and dislodge it from growing into the skin.  Sometimes this works, sometimes it doesn’t.  And of course, learning how to properly trim nails and practicing good trimming habits will take a bit more time.

When it comes to infected ingrown toenails, sometimes these options are simply not practical and patients will require surgical treatment for ingrown toenail removal.

As outlined on our homepage these are the traditional treatment options for ingrown toenails:

  • Partial toenail removal
  • Partial toenail and tissue (nail bed) removal
  • Matricectomy or Permanent toenail removal

Risks Associated with Infected Ingrown Toenails

The primary concern one needs to be worried about when it comes to an infected toe is the risk that the infection will enter the bone.  This is especially true for diabetics. If/when the infection reaches the bone in the toe, the toe will need to be amputated to prevent the infection from spreading.

Dr. Scott Kilberg of the Indiana Podiatry Group writes:

Nail tissue comes from a group of cells called the nail matrix.  Located under the skin at the base of the nail, the nail matrix grows nail outward.  It is closely associated with the end bone of the toe, which lies a very short distance underneath.

When an ingrown nail is present, and inflammation develops in the skin fold adjacent to that ingrown portion, bacteria can become trapped within and under the swollen skin.  In this tight space an infection can develop, and that is why some ingrown nails become red and drain pus.  Typically, this infection, even in diabetics, is limited and resolves with simple self-treatment measures like soaking, antibiotic ointment, or a basic oral antibiotic.

However, if this infection is allowed to smolder untreated for a long time (usually months), or if the area suffers repeated infections, the bacteria can eventually make their way down the channel alongside the nail and into the nail matrix.  From there, it is possible for the bone underneath to become infected.

For many diabetics, this can mean amputation of the end of the toe as bone infection, especially of the small bones of the foot, has a poor outcome with the extended use of intravenous antibiotics as opposed to larger bones elsewhere in the body with a better blood supply.