What is an Ingrown Toenail?
An ingrown toenail occurs when the corner or side of a toenail presses into or breaks the surrounding skin. This common form of foot problem usually affects the big toe. The affected toe may become painful, tender, red and swollen. An infection can develop if the skin is broken.
Mild ingrown toenails may improve when you reduce pressure, and the nail grows beyond the irritated skin. A persistent, recurrent or infected ingrown toenail needs professional assessment. People with diabetes, poor circulation, reduced sensation or a weakened immune system should seek advice promptly rather than treating ingrown toenails themselves.
Symptoms
Symptoms of an ingrown toenail may affect one or both sides. They include:
- pain or tenderness where the toenail meets the skin
- redness or a change in colour around the lateral nail fold
- swelling beside the toenail
- skin growing over part of the toenail corner
- discomfort when wearing shoes or walking
- bleeding, fluid or pus coming from the area if infection develops
The symptoms may begin as mild pressure. Pain, swelling and inflammation can increase as the ingrown nail presses into the soft flesh beside the toe.
Signs of an infected ingrown toenail
Broken skin can allow bacteria to enter the nail fold. An infected ingrown toenail may cause increasing pain, warmth, swelling, pus, an unpleasant smell or redness that spreads beyond the toenail.
An inflamed or infected nail fold may also be paronychia. A podiatrist or doctor can determine whether the problem is an ingrown nail, paronychia or both.
When to seek medical care
Arrange an assessment if:
- Pain is severe or worsening
- There is pus, spreading redness, warmth or increasing swelling
- The ingrown toenail repeatedly returns
- Home care has not helped
- The toenail is very curved, thick or difficult to trim
- An injury has damaged or loosened the nail plate
- You have diabetes, poor circulation, reduced sensation or a weakened immune system
Seek prompt medical care if an ingrown toenail is severely infected, you have fever, feel unwell, develop an open wound or notice redness spreading along the toe or foot.
Causes of Ingrown Toenails
Ingrown toenails can result from pressure, nail shape, or injury. An ingrown toenail occurs when pressure pushes a nail into the lateral nail fold or when surrounding tissue swells. Common causes of ingrown toenails include:
- improper nail trimming, including cutting the toenail too short
- rounding the toenail corners instead of cutting toenails straight across
- wearing tight shoes, pointed shoes or other tight footwear that compresses the toes
- repeated toe pressure during running, football or other activities
- stubbing the toe or dropping an object on it
- picking or tearing the toenail, which may leave sharp edges
- a naturally curved, wide or fan-shaped nail plate
Toe trauma can change how a toenail grows. Repeated pressure may also push a toenail corner into the skin. If the nail curves markedly, its shape may contribute to developing ingrown toenails. Curved nails sometimes run in families.
Poor foot hygiene does not directly cause ingrown toenails. Keeping your feet dry and your nail folds clean may, however, reduce irritation and the risk of a secondary infection.
Risk Factors
Your risk of developing ingrown toenails may be higher if you:
- Have a nail deformity or very curved or thick toenails
- Cut your nails very short or round the corners
- Wear shoes that do not fit properly or regularly wear enclosed shoes
- Take part in activities that repeatedly pressure the toes
- Have sweaty feet
- Have difficulty seeing, reaching or trimming your nails
- Have obesity, which may increase pressure on the toes and make nail care more difficult
- Have diabetes, poor circulation, reduced sensation or a weakened immune system
Contributing factors may occur together. Wearing tight-fitting shoes after improper nail trimming can increase the risk of developing ingrown toenails.
Diagnosis
A healthcare provider diagnoses an ingrown toenail by examining the toe. The assessment includes nail shape, the nail plate, the position of the ingrown toenail, tenderness, swelling and signs of infection. The nail bed lies beneath the nail plate, while ingrown toenails usually affect the lateral nail fold and surrounding skin. You may be asked about nail trimming, footwear, sport, injury, previous episodes and health conditions.
Tests are not usually needed. A clinician may arrange further investigation if the appearance suggests another nail disorder, a foreign body or an infection involving the underlying bone. Thick or discoloured nails may need assessment for fungal nail infection or other causes of thick toenails.
Home Care for a Mild Ingrown Toenail
Home care is suitable only when discomfort is mild, and there is no pus, spreading redness or significant swelling.
To reduce irritation:
- soak the foot in warm water for 10 to 20 minutes, then dry it well
- wear sandals or wear shoes with a wide, deep toe box
- avoid activities that repeatedly press on the painful toe
- allow the ingrown toenail to grow beyond the irritated skin
- keep the toe and foot dry between soaks
Do not cut down the side of an ingrown toenail, dig into the corner, pull the nail away or try to remove it yourself. These actions can leave a sharp nail edge, injure the skin and increase the risk of infection.
For selected mild cases, a clinician may separate the toenail from the skin using cotton packing, dental floss, taping or nail bracing. Do not push material beneath a painful ingrowing nail without professional guidance.
If you have diabetes, poor circulation, reduced sensation or a weakened immune system, do not rely on home treatment. Arrange an assessment with a healthcare professional or foot specialist.
Podiatry Care
Ingrown toenail treatment depends on symptom severity, infection and recurrence. Ingrown toenail management may include reducing pressure around the ingrown toenail, removing a nail spike, using packing or nail bracing, and educating the patient about foot and nail care.
Antibiotics do not correct an ingrown nail. They are not routinely needed after an ingrown toenail procedure. If cellulitis or another spreading bacterial infection is present, a doctor may prescribe an antibiotic, and the underlying foot problem may still need care.
Ingrown Toenail Surgery
A podiatrist may consider ingrown toenail removal if you have severe pain, a deeply embedded nail, infection or overgrown tissue. Removal may also be an option if conservative care has not prevented recurrence. Care includes assessment, nail avulsion when appropriate, and guidance on aftercare and recovery.
Partial nail avulsion removes only the portion of the ingrown toenail causing the problem, usually under local anaesthesia. The clinician separates and removes the affected part. For recurrent ingrown toenails, the clinician may treat part of the nail matrix to reduce regrowth. Total nail avulsion removes the whole toenail and is reserved for selected cases. A dressing protects the nail bed.
Recovery and Recurrence
A mild ingrown toenail may settle as swelling reduces and the ingrown toenail grows beyond the skin. Improvement depends on reducing pressure on the foot and avoiding injury. Recurrence is possible if the nail remains curved, its corners are cut back, or footwear compresses the toe.
After nail avulsion or another surgical approach, follow the dressing, activity and pain management instructions provided by your clinician. Protect the surgical site during healing. The surgery page should remain the main source for procedure recovery and recurrence information.
Complications
An untreated ingrown toenail can lead to persistent pain, overgrown tissue and infection of the nail fold. In long-standing cases, fragile granulation tissue called a pyogenic granuloma may form beside the toenail. Infection may spread into the surrounding skin. Infection involving the underlying bone is uncommon but more serious.
Complications from ingrown toenails are more concerning if you have diabetes, poor circulation or reduced sensation because a foot injury or infection may be harder to detect or heal. Read more about diabetic foot care.
Prevention
You cannot prevent all ingrown toenails, but these steps may reduce the risk:
- Cut straight across the toenail
- Keep your nails straight rather than rounding the corners
- Leave each toenail long enough for its corners to remain visible
- Do not tear, pick or dig into the nail corners
- Use clean nail clippers and avoid injuring the surrounding skin
- Wear shoes that fit properly, with adequate length and a roomy toe box
- Change footwear if a sport or activity repeatedly presses on the toes
- Keep each foot clean and dry
- Arrange professional foot and nail care if you cannot safely reach or see your toenails
Correct trimming, including keeping nails straight across, may help prevent ingrown toenails. If you continue developing ingrown toenails despite suitable footwear and trimming your nails straight across, seek an assessment. The shape of the toenail or nail fold may require a different approach.
Podiatry Assessment in Singapore
The Foot Practice’s podiatrists can examine the ingrown toenail, assess for infection, reduce pressure and discuss appropriate care. Arrange a podiatry appointment if the toe is painful, recurrent or difficult to manage safely, or if you have other foot conditions.
Frequently Asked Questions
Can an ingrown toenail heal on its own?
A mild ingrown toenail may improve when you relieve pressure, and the toenail grows past the irritated skin. Persistent pain, pus, spreading redness or repeated episodes need professional assessment.
Should I cut out an ingrown toenail?
No. Cutting down the side or digging out the corner can leave a sharp nail spike and injure the skin. Let the toenail grow and see a podiatrist if it remains painful.
How do I know if an ingrown toenail is infected?
Increasing pain, warmth, swelling, pus, an unpleasant smell or spreading redness can indicate infection. Seek prompt care if you have these symptoms, particularly if you have diabetes or poor circulation.
Do antibiotics cure an ingrown toenail?
Antibiotics may be needed for a spreading bacterial infection, but they do not correct the ingrown toenail pressing into the skin. You may still need podiatry or medical care to address the mechanical cause.
When is ingrown toenail surgery considered?
Ingrown toenail surgery may be considered for severe pain, a deeply embedded toenail, overgrown tissue, recurrent infection or repeated ingrown toenails that do not improve with conservative care.
