ConditionSkin, hair & nails
Ingrown Nail (Ingrown Toenail)
An ingrown nail happens when the edge of a nail, usually the big toenail, grows or is pressed into the surrounding skin. It causes pain, redness and swelling along the side of the nail, and can become infected with pus and extra tissue growth. Common causes are cutting nails too short or curved, tight shoes and naturally curved nails. Mild cases improve with soaks and proper trimming; recurring or infected ones are treated with a quick office procedure.
Also called: Ingrown toenail, onychocryptosis, ingrowing toenail, unguis incarnatus
At a glance
- What it is
- A nail edge growing into the skin fold beside it.
- Most common site
- The big toe; fingernails are less often affected.
- Causes
- Cutting nails short or rounded, tight shoes, injury, naturally curved nails, sweaty feet.
- Stages
- Pain and redness, then infection with pus, then overgrown red tissue.
- Home care
- Warm soaks, lifting the nail edge, roomy shoes, no "bathroom surgery".
- Medical treatment
- Partial nail removal, often with a chemical to stop regrowth.
When to get help
See a doctor within a day or two
- An ingrown toenail with spreading redness up the foot, red streaks or fever
- Any ingrown or infected toenail in someone with diabetes, poor circulation or numb feet
- Severe throbbing pain with a pocket of pus
Book a routine appointment
- Pain, redness and swelling that do not improve after 3 to 5 days of home care
- Pus or drainage, or a raised, red, bleeding lump of tissue beside the nail
- Ingrown nails that keep coming back
Usually safe to manage at home
- Mild tenderness and redness along the nail edge without pus, in someone without diabetes or circulation problems
What causes an ingrown nail
- Cutting nails too short or rounding the corners, which lets the skin fold over the nail edge so it grows into it
- Tight or narrow shoes and high heels pressing the toes together
- Naturally curved or fan-shaped nails (inherited)
- Injury: stubbing, dropping something on the toe, or repeated pressure from kicking or running
- Sweaty feet, which soften the skin
- Poor posture of the toe or bunions
- Picking or tearing the nails
- Some medicines, such as isotretinoin, which cause overgrowth of tissue around the nail
Teenagers and young adults are most commonly affected.
Symptoms and stages
| Stage | Signs |
|---|---|
| Stage 1 (mild) | Pain when pressing on the side of the nail, slight redness and swelling |
| Stage 2 (infected) | Increased pain, swelling, warmth, pus or drainage, a bad smell |
| Stage 3 (chronic) | Red, shiny, raised tissue (granulation tissue) overgrowing the nail edge, bleeding easily |
Infection around the nail is called paronychia. If redness spreads into the toe and foot, it can become cellulitis.
Home treatment for a mild ingrown toenail
- Soak the foot in warm water for 10 to 20 minutes, 2 to 3 times a day. Adding Epsom salt is optional.
- Lift the nail edge gently after soaking and place a small piece of clean cotton or dental floss under the corner to guide the nail to grow over the skin. Change it daily.
- Apply petroleum jelly and cover with a bandage.
- Wear roomy shoes or open-toed sandals until it improves.
- Pain relief: acetaminophen (paracetamol) or ibuprofen at the label dose.
What to avoid:
- cutting a V into the nail or digging out the corner yourself, which often makes it worse
- cutting the nail shorter
- using sharp tools on infected skin
If you have diabetes, numb feet or poor circulation, skip home treatment and see a doctor or podiatrist.
Medical treatment
- Lifting and splinting: a clinician may insert cotton, a dental floss wedge or a plastic gutter splint under the nail edge.
- Partial nail avulsion: under a local anesthetic injection at the base of the toe, the ingrown strip of nail is removed. It takes about 15 to 30 minutes.
- Matrixectomy: applying phenol or sodium hydroxide to the nail root, or surgically removing it, so that strip does not grow back. This greatly reduces recurrence.
- Total nail removal for severe or repeated cases.
- Antibiotics only when infection spreads into the surrounding skin. They are not a substitute for removing the ingrown nail.
After the procedure, keep the toe clean, soak it daily, and wear loose shoes. Most people walk the same day, and the area heals in 2 to 4 weeks.
Ingrown fingernails
Fingernails become ingrown less often, usually from biting, picking or manicures that cut too deep. Treatment is similar: warm soaks, gentle lifting and medical care for infection.
Complications
- infection of the toe and surrounding skin
- abscess formation
- bone infection (rare)
- in people with diabetes, foot ulcers and serious infections; see diabetic foot
- recurrence
How to prevent ingrown toenails
- Cut toenails straight across, not curved, and leave them level with the tip of the toe.
- Use clean, sharp nail clippers.
- Wear shoes with enough room for your toes; avoid tight or pointed shoes.
- Wear protective footwear for sports or work with risk of toe injury.
- Keep feet clean and dry.
- People with diabetes should check feet daily and have nails trimmed by a podiatrist if needed.
Frequently asked questions
How do I fix an ingrown toenail at home?
Soak your foot in warm water 2 to 3 times a day, gently lift the nail edge and place a small piece of cotton or floss under it, apply petroleum jelly and wear roomy shoes. If it does not improve in a few days or shows signs of infection, see a doctor.
How do I know if my ingrown toenail is infected?
Signs of infection include increasing pain, swelling, warmth, redness spreading around the toe, pus or drainage, a bad smell and overgrown red tissue. Spreading redness, red streaks or fever need prompt medical care.
Should I cut out an ingrown toenail myself?
No. Cutting into the nail corner or digging it out often causes infection and makes the nail grow back more ingrown. A doctor or podiatrist can remove the ingrown portion safely with local anesthetic in a few minutes.
Does ingrown toenail removal hurt?
The numbing injection at the base of the toe stings briefly, but the procedure itself is not painful. Afterward, the toe may ache for a few days, relieved by over-the-counter pain medicine, elevation and soaks.
Will an ingrown toenail come back after removal?
It can, especially if only the nail edge was removed. Treating the nail root with a chemical such as phenol (matrixectomy) prevents that strip from growing back and greatly lowers recurrence. Cutting nails straight across and wearing roomy shoes also help.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Dermatology: How to treat an ingrown toenail
- American Academy of Family Physicians (AAFP): Management of ingrown toenails
- American College of Foot and Ankle Surgeons: Ingrown toenail
- MedlinePlus: Ingrown toenail
- NHS: Ingrown toenail