Condition

Ingrown Toenail

An ingrown toenail is a nail edge that has grown into the skin beside it. It is painful, it becomes infected easily, and digging at it yourself is what makes it come back.
At a Glance

An ingrown toenail happens when the edge of the nail presses into or pierces the skin fold beside it, almost always on the big toe. The usual causes are cutting the nail curved instead of straight across, tight shoes, an injury, or nails that are naturally curved.

A mild one often settles with warm soaks and roomy shoes. The definitive fix is a small in-office procedure that removes the offending strip of nail and usually treats the tissue underneath so it does not grow back.

The honest catch: repeatedly digging at the corner at home is the most common route to infection and to it happening again and again.

Key Facts

How CommonVery common. One of the most frequent reasons people see someone about a foot problem.
Who Gets ItTeenagers and young adults most, and older adults with thickened nails. More likely with sweaty feet, tight shoes, and curved nails that run in families.
Chronic or CurableCurable. Removing the nail edge along with a chemical treatment of the nail root stops that strip regrowing in the large majority of cases.
Rx RequiredNo for a mild one. An antibiotic is sometimes needed if it is infected.
ContagiousNo.
CostAn in-office partial nail removal is usually a few hundred dollars and is generally covered by insurance.

Symptoms

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An ingrown toenail is almost always one corner of one toe, and the pain is out of proportion to how small the problem looks.

What it looks and feels like

Pain along one edge of the nail — worse when pressed, and worse in shoes.
A swollen, red or darkened fold of skin — pushed up against the nail edge.
Tenderness before anything is visible — pressure pain often comes first.
Clear fluid, yellow fluid or pus — a sign it has become infected.
Overgrown, shiny tissue at the edge — soft, lumpy and bleeds easily. This is called granulation tissue, and it means the nail has been irritating the skin for a while.
A sharp spike you can feel — the nail corner has pierced the skin fold.
Throbbing at night, or pain when a bedsheet touches the toe.

Where it shows up

  • The big toe, on either edge, in the large majority of cases.
  • Other toes occasionally, usually after an injury or with unusually curved nails.
  • Both sides of the same nail in people whose nails are strongly curved.

How it looks on different skin tones

On light skin the fold looks bright red. On brown and Black skin it usually looks dark brown, purple or grey rather than red, so swelling, warmth and tenderness are more reliable signs than colour. Once it settles, the skin at the edge is often left darker for a few months.

Light
Medium
Brown
Deep

If your painful nail does not fit this pattern, see Lookalikes near the bottom of this page.

Causes & Risk Factors

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An ingrown toenail is a mechanical problem, not an infection. The nail plate is a flat sheet growing forward out of a groove of skin on each side. If the corner of that sheet is left as a sharp spike, or if the nail is pushed sideways into the groove, the edge digs into the skin fold. The body treats it exactly like a splinter: inflammation, swelling, and eventually overgrown tissue and infection around the foreign object. Nothing heals while the nail edge is still in there, and that is the key point.

The usual reasons are cutting the nail curved to follow the shape of the toe, which leaves a spike at each corner; cutting too short, so the fold rolls over the end; shoes or socks that press the sides of the toe; stubbing the toe or dropping something on it; sweaty feet, which soften the fold so the nail edge cuts in more easily; and nails that are simply curved by inheritance, which is why some people get this over and over from childhood. Thickened nails from a fungal infection make it more likely, and so do a few medicines, including isotretinoin and certain cancer treatments.

What Hurts and What Helps

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What Makes It Worse

  • Cutting the nail into a curve, or cutting down the side to chase the spike. This is the single most common cause, and doing it during a flare almost guarantees a repeat.
  • Digging at the corner with clippers, tweezers, scissors or a needle. Bathroom surgery leaves a fragment behind, opens the skin, and is how most ingrown toenails become infected.
  • Cutting a V-shaped notch in the middle of the nail. It is a well-travelled internet suggestion and it does nothing. Nails do not grow inward toward a notch.
  • Narrow, pointed or short shoes, and tight socks or tights.
  • Repeated pressure from running, football, dancing or walking downhill.
  • Damp feet all day, which soften the skin fold so the nail edge cuts in more easily.
  • Waiting. Overgrown tissue builds up over weeks and makes the eventual procedure more involved.

Daily Habits That Help

  • Soak the toe in warm water for ten to twenty minutes, two or three times a day. It softens the fold and eases the pain.
  • Wear open or wide shoes while it settles, and no shoe at all where you can manage it.
  • Lift the corner gently, once, with a tiny wisp of cotton or dental floss tucked under the nail edge after soaking, and change it daily. Gently is the whole instruction. If it hurts, stop.
  • Keep it clean and covered, with a plain ointment and a dressing.
  • Take ibuprofen for the pain and swelling if you can take it.
  • Cut the nail straight across, level with the end of the toe, and file the corners smooth rather than rounding them off. Cut after a bath, when the nail is soft.
+2 more
  • Get it dealt with properly if two weeks of this has not worked, or if it keeps coming back. The procedure people are afraid of is quick, done under local anaesthetic, and is the thing that actually ends the cycle.
  • If you have diabetes, poor circulation or numbness in your feet, do not treat this at home at all. Have it looked at instead.

Try at Home

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Reasonable for a mild ingrown toenail with no pus, and only if the feeling and circulation in your feet are normal. Two weeks is a fair trial.

Always
The one habit that prevents this. Cut straight across, level with the end of the toe, and file the corners smooth instead of rounding them off. Cutting into a curve leaves a spike at each corner, which is what digs in. Cut after a bath, when the nail is soft.
Always
Soak the toe in warm water for ten to twenty minutes, two or three times a day. It softens the skin fold, eases the pain, and keeps the area clean. It will not push the nail out on its own, but it makes everything else easier.
Moderate evidence
Takes down the pain and the swelling together, which is useful both for a mild flare and for the first day or two after a procedure. Take it with food.
Limited evidence
After soaking, gently tuck a tiny wisp of cotton or a strand of dental floss under the nail edge to lift it off the skin, and change it daily. Gently is the whole instruction — if it hurts, stop. This is the only home manoeuvre worth trying, and it is not the same as digging at the corner.
Limited evidence
A thin layer under a dressing keeps the broken skin at the nail edge moist and covered. It will not treat an established infection, and it will not help while the nail edge is still embedded. Some people become allergic to it with repeated use.
Moderate evidence
A plain, cheap alternative to an antibiotic ointment for keeping the nail fold covered and moist under a dressing, with nothing in it to become allergic to.
Limited evidence
An alternative to plain warm water when the nail fold is weeping or has overgrown tissue. It dries the area and reduces the oozing.

When to See a Dermatologist

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See someone if:

  • There is pus, spreading redness, increasing pain, or you feel unwell.
  • Two weeks of soaking and roomy shoes has not helped.
  • The same nail has done this before.
  • There is soft, overgrown tissue at the nail edge.
  • The nail is also thickened, discoloured or crumbly, which suggests a fungal infection is part of the picture.

Do not treat a foot problem at home if you have diabetes, poor circulation, or reduced feeling in your feet. In those situations a small toe problem can become a serious one quickly, and it should be looked at early. That is a reason to make the appointment, not a reason to be alarmed.

What the visit gets you: the offending strip of nail removed properly under local anaesthetic in about fifteen minutes, and the option of treating the nail-growing tissue underneath so that strip does not come back. That is the difference between fixing it and postponing it.

What Happens at the Dermatologist?+

There is no test that diagnoses an ingrown toenail. It is recognised on sight, and it does not need anything else.

Two tests are done occasionally, and each answers a different question:

A bacterial swab — taken when there is pus, or when the toe is not settling on the usual antibiotic, to identify which bacteria are involved.

A nail clipping sent for fungal testing — done when the nail is also thick, crumbly or discoloured. A fungal nail changes shape and thickness, and it keeps causing ingrowing until it is treated.

A dark streak in the nail, a lump underneath it, or a wound at the nail edge that will not heal despite proper treatment is a reason for a biopsy. That is uncommon, but it is the one situation where looking is not enough.

Prescription Treatments

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Used when the toe is genuinely infected. Nothing here fixes the nail edge itself, which is the reason it happened.

Topical prescriptions
Moderate evidence
A prescription antibiotic ointment for a nail fold that is genuinely infected but not spreading. It handles the infection; it does nothing about the nail edge that caused it, which still has to come out.
Topical prescriptions
Limited evidence
Sometimes used on the soft, lumpy overgrown tissue at the nail edge to shrink it down. It helps that part, but the tissue only truly settles once the nail edge is removed, so it is a supporting act.
Pills and injections
Moderate evidence
For an infection that has spread past the nail fold into the toe, with swelling, warmth and spreading redness. Important to be clear: antibiotics do not cure an ingrown toenail. They treat the infection while the nail edge still needs removing.
Pills and injections
Moderate evidence
Used when the infection is not settling on a standard antibiotic, or when resistant staph is suspected. Same caveat: it treats the infection, not the nail.

In-Office Treatments

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This is what actually ends it. The whole thing takes about fifteen minutes under local anaesthetic.

Strong evidence
The definitive treatment, and it is much less dramatic than people fear. The toe is numbed with an injection at its base, then the offending strip along one edge — often about a fifth of the nail — is lifted out. About fifteen minutes, and you walk out. The honest catch: removing the nail alone lets it grow back, and it returns roughly half the time, which is why the chemical step below is usually added.
Strong evidence
The step that makes it permanent. After the nail strip is removed, phenol is applied for a minute or so to the small area of tissue that grows that strip, so it does not grow back. It adds almost nothing to the appointment. Expect the toe to weep clear fluid for two to six weeks afterwards — that is normal, not infection, and nobody warns people about it.
Limited evidence
Professional thinning and trimming of a thickened or fungal nail. Useful when a bulky nail is the reason it keeps digging in, and it is often done alongside treatment for the fungus. It manages the problem rather than solving it, and it needs repeating.
Limited evidence
A small wire or adhesive brace glued across the nail to gradually flatten a curved one. It appeals because nothing is cut, and it can help a mildly curved nail without infection. The evidence is thin, it takes months, and it does not suit an actively infected or deeply embedded nail.

What to Expect

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Step 1
With home care for a mild one

Pain eases within a few days of soaking and getting out of tight shoes. If there is no clear improvement in two weeks, home care is not going to be the answer.

Step 2
The day of the procedure

The toe is numbed with an injection at its base, which is the part people dread and the part that is over in a minute. The offending strip of nail is then lifted out. The procedure itself is not painful and takes about fifteen minutes.

Step 3
The first 48 hours

Sore and throbbing as the anaesthetic wears off, helped by ibuprofen and by keeping the foot up. Most people are back in a normal shoe within a day or two.

Step 4
Weeks two to six

Daily soaks and a dressing while the edge heals. If phenol was used on the nail-growing tissue, the toe weeps clear fluid for two to six weeks. That is expected rather than infection, and it is the part nobody warns people about.

Step 5
Three to twelve months

The nail regrows minus the removed strip and ends up slightly narrower. Most people cannot tell from a normal distance.

Step 6
The honest long view

Removing the nail strip on its own lets it grow back, and it returns roughly half the time. Treating the nail-growing tissue at the same time, usually with phenol, brings that down to a small percentage. That is why the version with the chemical step is the one worth having.

Complications

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Most ingrown toenails are painful and nothing more. Left alone or picked at, a few things follow.

Infection
The usual complication. Pus, swelling and increasing pain around the nail fold, treated with a topical or oral antibiotic. Antibiotics will not solve it while the nail edge is still embedded.
Overgrown tissue
Soft, lumpy granulation tissue at the edge that bleeds easily. It settles once the nail edge is out, but it makes the procedure more involved.
Recurrence
The most common outcome of home surgery, and of nail removal without treating the nail-growing tissue underneath.
Nail changes
Repeated injury or repeated procedures can leave a nail permanently thickened, ridged or narrower.
Bone infection
Rare, and mostly in people with diabetes or poor circulation. A deep, long-standing infection at the toe can reach the bone.
Foot ulcers
In people whose feet are numb from diabetic nerve damage, an ingrown toenail can go unnoticed and become an ulcer. This is the reason home treatment is not advised in that group.

Lookalikes

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A few other things cause pain at the nail edge.

  • Paronychia — infection of the skin fold itself, without the nail growing into it. Swollen, red and tender all the way around the nail, often with a visible pocket of pus. More common on fingers.
  • Nail fungus (onychomycosis) — thickened, yellow, crumbly nail. Not painful on its own, but the change in shape often causes ingrowing on top of it.
  • A wart or corn beside the nail — a hard, painful lump from pressure, without the nail edge piercing the skin.
  • Pincer nail — a nail curved so tightly that it pinches the nail bed inward. Painful along the whole edge rather than at one corner, and it needs a different approach.
  • A splinter or foreign body — sudden pain at the nail edge after standing on something, with no history of nail trouble.
  • Subungual melanoma — rare, but the reason not to ignore a dark streak in a nail, a dark patch spreading onto the skin at the base of the nail, or a nail wound that will not heal. Worth showing to a dermatologist.

The clue for a genuine ingrown toenail is that it hurts at one corner, and pressing that corner reproduces the pain exactly.

FAQ+
Can I fix an ingrown toenail myself?A mild one, sometimes. Soaking, roomy shoes and lifting the corner gently with a wisp of cotton can work. Repeatedly digging at the corner does not, and it is the most common way people end up with an infection and a nail that keeps doing this.
Should I cut a V into the middle of the nail?No. It is a popular suggestion online and it does nothing. Nails do not grow inward toward a notch.
Does the procedure hurt?The numbing injection at the base of the toe stings for under a minute. After that you feel pressure, not pain. Most people find the anticipation was worse than the procedure, and the toe is more comfortable that evening than it was that morning.
Do they take the whole nail off?Usually not. A partial nail avulsion removes only the offending strip along one edge, often about a fifth of the nail. The rest stays. Total removal is reserved for unusual cases.
What is a matrixectomy?It is treatment of the nail matrix, the tissue at the base that grows the nail, so the removed strip does not grow back. It is most often done with phenol, a chemical applied for a minute or so at the end of the procedure. It is what makes the fix permanent.
Will my toenail look strange afterwards?It will be slightly narrower on the treated side. Most people cannot tell unless they are looking for it.
Will it come back?If only the nail is removed, it comes back around half the time. With a phenol matrixectomy, recurrence drops to a small percentage.
Do I need antibiotics?Only if it is genuinely infected. Antibiotics alone will not cure it while the nail edge is still embedded. The nail has to come out for the infection to settle.
How should I cut my toenails?Straight across, level with the end of the toe, not rounded and not shorter than the toe tip. File the corners smooth. Cut after a bath, when the nail is soft.
Do tight shoes really cause this?Yes. Narrow or pointed shoes, and shoes half a size too short, are a genuine cause. So are tight socks and tights.
Can children get ingrown toenails?Yes, often, particularly teenagers with sweaty feet and fast-growing nails. The same procedure is done in children, with more attention to the numbing.
I have diabetes. Can I still soak it?Ask first. Anyone with diabetes, poor circulation or numbness in the feet should have a foot problem looked at rather than treated at home, because small problems progress faster and can be felt less.