A toenail that appears to be growing sideways is usually a sign of an ingrown nail, a common condition called onychocryptosis. This occurs when the edge of the nail plate curves or pushes into the soft tissue of the nail groove instead of growing straight over the skin. This misalignment causes irritation, redness, and swelling, most often affecting the big toe. Understanding the underlying cause helps in addressing the problem effectively and preventing recurrence.
Common Reasons for Sideways Nail Growth
The primary factor contributing to ingrown nails is often how the nail is trimmed. Cutting the toenails too short, especially rounding the corners, encourages the skin to fold over the nail edges as the nail grows out. This leads to the nail penetrating the flesh.
Ill-fitting footwear is another major mechanical cause, as shoes that are too narrow or tight compress the toes together. This constant side pressure forces the nail plate to push into the surrounding skin, triggering the nail to grow into the soft tissue. Tight shoes, particularly those with a pointed toe box, can exacerbate the issue by repeatedly jamming the nail edge against the skin.
Physical trauma to the toe, such as stubbing it or dropping a heavy object, can disrupt the nail bed, causing the nail to grow abnormally or with a distorted shape. Some individuals also have a genetic predisposition for nails that naturally curve excessively, a condition known as pincer nail, which increases the likelihood of ingrowth. Fungal infections like onychomycosis can also thicken and distort the nail plate, causing it to become misshapen and press into the skin.
Self-Care Techniques for Immediate Relief
For mild cases without signs of infection, several self-care techniques can provide immediate relief and encourage the nail to grow correctly. Soaking the affected foot in warm water two to four times a day for 15 to 20 minutes helps soften the nail and surrounding skin. Adding Epsom salts to the water may further reduce inflammation and soothe the tender area.
After soaking, the area should be dried completely, and the ingrown nail edge can be gently lifted. A small piece of sterile cotton or a thin wisp of dental floss can be carefully placed under the nail edge to create a barrier between the nail plate and the skin. This padding gently elevates the nail, redirecting its growth to move over the skin rather than into it.
The cotton or floss needs to be replaced daily after each soak to maintain cleanliness and effectiveness. For temporary pain management, over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or acetaminophen can alleviate discomfort and reduce localized swelling. When trimming the nails, use clean, sharp clippers and cut straight across the top, avoiding the temptation to curve the edges or cut the nails too short.
Knowing When to See a Podiatrist
While home care is often sufficient for minor irritation, certain signs indicate that professional medical intervention is necessary. The presence of infection is a major threshold, marked by symptoms such as worsening pain, severe swelling, and warmth that spreads beyond the toe. Visible pus, drainage from the side of the nail, a foul odor, or red streaks extending away from the toe are clear indicators of a spreading bacterial infection.
If home treatments fail to improve the condition after two to three days, or if the pain interferes with walking, a podiatrist should be consulted. Certain health conditions significantly increase the risk of complications from an ingrown nail, making immediate professional care mandatory. Individuals with diabetes, peripheral neuropathy, or poor circulation should not attempt self-treatment for any foot issue, due to the high risk of rapid infection and severe complications.
A podiatrist can perform a partial nail avulsion, a minor in-office procedure where the ingrown portion of the nail is removed using sterile instruments under local anesthetic. This procedure offers a definitive solution and prevents the nail from continuing to cut into the surrounding tissue, allowing the toe to heal properly. In cases of chronic recurrence, the practitioner may use a chemical agent to permanently prevent the removed section of the nail matrix from growing back.