Ingrown Toenail

Overview

An ingrown toenail happens when the edge of a toenail grows into the skin beside it. This can cause pain, redness, and swelling. It most often affects the big toe. The medical word for it is onychocryptosis (say: on-ih-ko-krip-TOE-sis).

Yes, ingrown toenails are common. They are one of the most frequent foot problems seen by doctors, nurses, and foot specialists.

Anyone can get an ingrown toenail, but they are more common in teenagers and young adults, people who play sports, people with sweaty feet, and people whose nails naturally curve inward. They can also affect children and older adults. Older adults with diabetes, poor circulation, or changes in their nails may need extra care.

Symptoms

Common symptoms

• Pain along one or both sides of the toenail, especially when wearing shoes or pressing on the toe
• Redness, swelling, and tenderness around the nail edge
• A feeling of pressure or throbbing in the toe
• Hard or thickened skin beside the nail
• Pus or fluid around the nail if infection develops
• The nail edge looking curved into the skin
• Pain when walking or wearing closed shoes
• The toe feeling warmer than usual

Symptoms in children

• Children may complain of toe pain or not want to walk, run, or play sports
• They may hide the toe because it looks sore or embarrassing
• Young children may be fussy or avoid wearing certain shoes
• Check children’s feet if they limp or seem uncomfortable in shoes

Symptoms in older adults

• Older adults may have less feeling in their feet, so pain may be noticed late
• Nails may become thicker or more curved with age, making ingrowing more likely
• Diabetes and poor circulation can make infection more serious
• Swelling, redness, or warmth should be checked promptly if you have diabetes or circulation problems

Causes

Main causes

• Cutting toenails too short or rounding the corners
• Wearing shoes or socks that are too tight and press on the toes
• Repeated pressure or injury to the toe, such as from running, kicking, or stubbing it
• Nails that naturally curve inward or are unusually thick
• Sweaty feet that soften the skin and make it easier for the nail to press in

Risk factors

• Playing sports that put pressure on the toes, such as football or running
• Having a family history of curved or ingrown nails
• Having diabetes, poor circulation, or a weakened immune system
• Being an older adult with thicker nails or reduced feeling in the feet
• Having a fungal nail infection
• Wearing tight or pointed shoes for long periods
• Previous ingrown toenail or toe injury

When to see a doctor

See a doctor urgently if:

• You have spreading redness, swelling, or red streaks
• You have a fever or feel unwell
• There is pus, a bad smell, or severe pain
• You have diabetes, poor circulation, or a weakened immune system and your toe looks infected
• You cannot walk or put weight on the foot because of the pain

Book a routine appointment if:

• The pain or swelling does not improve after a week or two of home care
• The ingrown toenail keeps coming back
• The nail looks deformed or is very thick
• You have diabetes and notice any new foot problem
• A child has repeated toe pain or avoids walking
• You are not sure how to care for the toe safely

Diagnosis

A doctor, nurse, or foot specialist can usually diagnose an ingrown toenail by looking at the toe and gently pressing around the nail. They may ask about your shoes, activities, nail care, and health conditions. Only a qualified healthcare professional can confirm whether you have an ingrown toenail or another foot problem.

Tests that may be done

• Most people do not need tests
• A sample of pus or fluid may be checked if infection is suspected
• An X-ray may be done if a deeper infection or bone problem is suspected, but this is uncommon

What to expect at your appointment

The exam is quick and usually not painful, though the toe may be tender. The clinician will check for redness, swelling, pus, and how the nail is growing. They may show you how to care for the toe at home or refer you to a foot specialist.

Treatment

Most ingrown toenails improve with home care. The aim is to reduce pressure on the skin, keep the area clean, and treat infection if present. If home care is not enough, a clinician may remove the edge of the nail or recommend a minor procedure.

Self-care at home

• Soak the foot in warm water for short periods to soften the skin and ease pain
• Keep the toe clean and dry, and change socks daily
• Wear wide, comfortable shoes and avoid tight or pointed shoes until the toe heals
• Do not cut the nail down the side or pick at the nail edge
• Trim nails straight across and not too short
• Ask a pharmacist about pain relief that is suitable for you
• Place a small piece of clean cotton under the nail edge only if a clinician advises it
• Check the toe daily for spreading redness, pus, or worsening pain

Medical treatments

A doctor or foot specialist may gently trim the ingrown edge, remove a small piece of nail, or treat an infection if one is present. They may also give advice on footwear and nail care. If infection is suspected, a clinician will decide whether treatment for infection is needed. You should not use leftover or borrowed medicines on the toe.

When is surgery considered?

If an ingrown toenail keeps coming back or is very painful, a minor procedure may be done to remove part of the nail or the nail root so it does not grow back in the same way. This is usually done with local numbing so the toe is comfortable during the procedure. Your clinician will explain the benefits and risks.

Living with this condition

Keep pressure off the toe while it heals. Wear comfortable shoes, rest when it is sore, and check the toe each day. If you have diabetes, follow your usual foot care plan and check your feet regularly.

Lifestyle tips

• Choose shoes with room for your toes
• Wear clean, dry socks and change them if your feet get sweaty
• Trim nails straight across rather than rounding the corners
• Avoid standing or walking for long periods if the toe is very sore
• Wash and dry your feet carefully every day
• Do not share nail clippers or foot care tools

Diet and exercise

No special diet is needed for an ingrown toenail. Regular physical activity is good for circulation, but avoid activities that press on the sore toe until it heals. If you have diabetes, managing your blood sugar as advised by your healthcare team is important for foot health.

Mental health and emotional wellbeing

Toe pain can make you tired, irritable, or worried, and it can affect sleep, work, and exercise. This is understandable. If the problem is affecting your mood or you feel overwhelmed, talk to a clinician. If you have thoughts of self-harm, contact your local emergency number or a crisis support service right away.

Prevention

Yes, many ingrown toenails can be prevented. Cut toenails straight across and not too short, wear shoes that fit well, and keep feet clean and dry. People with diabetes should have regular foot checks.

Vaccines

There is no vaccine for ingrown toenails.

Screening programmes

No routine screening is needed for ingrown toenails. People with diabetes should have regular foot checks as part of their diabetes care.

Complications

If left untreated

• The skin around the nail can become infected
• Infection can spread deeper into the toe or foot, especially in people with diabetes or poor circulation
• Long-term pain and difficulty walking
• Permanent changes in the shape of the nail
• Rarely, a deeper bone infection

Long-term outlook

Most people with an ingrown toenail recover well with home care and simple treatment. See a clinician early if you have diabetes, poor circulation, or signs of infection. With the right care, the toe usually heals and you can return to normal activities.

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