Ingrown Toenail: Symptoms, Treatment & Prevention

What Are the Symptoms of an Ingrown Toenail?

The main symptoms of an ingrown toenail include pain and tenderness along the nail edge, redness and swelling of the surrounding skin, and in infected cases, drainage of pus and throbbing pain. The big toe is most commonly affected, and symptoms typically worsen without treatment.

An ingrown toenail develops when the edge of the nail grows into the soft skin of the nail fold, creating a small wound that becomes increasingly painful. The condition most commonly affects the big toe and can occur on one or both sides of the nail. Understanding the progression of symptoms helps you determine when home care is sufficient and when medical attention is needed.

The initial symptoms are typically mild, with localized pain and tenderness at the nail edge that becomes noticeable when pressure is applied, such as when wearing shoes. The skin around the affected nail edge becomes red and slightly swollen. At this stage, the condition often responds well to conservative home treatment measures.

As the nail continues to dig into the skin, a small wound forms that provides an entry point for bacteria or fungi. This can lead to infection, known as paronychia, which causes additional symptoms including increased pain, warmth around the affected area, and the formation of pus. The skin may become shiny and taut, and you may experience a throbbing or pulsating sensation that persists even at rest.

Early Warning Signs

Recognizing early symptoms allows for prompt treatment and helps prevent progression to infection. The earliest sign is usually mild discomfort along one edge of the toenail, particularly noticeable when putting on shoes or during activities that put pressure on the toes. You may notice that the skin appears slightly pink or red compared to the surrounding tissue.

At this early stage, the nail edge may feel sharp when you run your finger along it, and the adjacent skin may feel slightly tender to touch. Some people notice that the nail appears to be curving more than usual into the skin. Addressing the condition at this point with proper nail care and footwear modifications can often resolve it without further intervention.

Signs of Infection (Paronychia)

When bacteria enter the wound created by the ingrown nail, infection develops rapidly. The affected area becomes significantly more painful, and the redness extends beyond the immediate nail edge. Swelling increases, and you may notice that the skin around the nail appears puffy and inflamed.

Pus formation is a clear indicator of bacterial infection. You may see yellowish or whitish fluid collecting around the nail fold, sometimes draining spontaneously. In some cases, overgrowth of inflamed tissue called granulation tissue develops over the nail edge, appearing as red, moist, and sometimes bleeding tissue. This granulation tissue indicates a more advanced stage that typically requires professional treatment.

How Can I Treat an Ingrown Toenail at Home?

For mild ingrown toenails, soak the foot in warm water for 15-20 minutes several times daily, gently file the sharp nail edge, place moistened cotton under the nail edge to lift it, and apply antiseptic. These conservative measures can resolve early-stage ingrown toenails within 2-4 weeks.

Conservative home treatment is effective for early-stage ingrown toenails that show no signs of significant infection. The primary goals of home care are to reduce pressure on the affected area, soften the nail to make it more pliable, and encourage the nail to grow outward rather than into the skin. Success requires patience and consistent daily care.

Before beginning treatment, assess the severity of your condition. Home treatment is appropriate when symptoms are mild to moderate, with localized pain and minimal swelling but no pus formation or spreading redness. If you have diabetes, peripheral vascular disease, or a compromised immune system, consult a healthcare provider even for seemingly mild cases, as complications can develop rapidly in these conditions.

The treatment process typically takes several weeks to show complete resolution, as you need to allow the nail to grow beyond the point where it was embedded in the skin. During this time, choose footwear carefully, wear open-toed shoes or sandals when possible, and avoid activities that put excessive pressure on the affected toe.

Step-by-Step Home Treatment

Begin by soaking the affected foot in lukewarm water for 15 to 20 minutes. The water should be comfortably warm but not hot, as excessive heat can increase inflammation. This soaking softens both the nail and surrounding skin, making subsequent steps easier and less painful. You can add a mild soap or a tablespoon of salt to the water, though plain warm water is also effective.

After soaking, carefully dry the foot and examine the nail edge. Using a clean nail file, gently file the top surface of the nail to thin it slightly, and smooth any sharp edges along the ingrown side. Avoid cutting into the nail or digging at the embedded edge, as this can worsen the problem or introduce infection.

The cotton wedge technique is a cornerstone of conservative treatment. Take a small piece of clean cotton or gauze, moisten it with water or antiseptic solution, and carefully insert it under the nail edge that is growing into the skin. This lifts the nail slightly, allowing it to grow over the skin rather than into it. The cotton should be changed daily and re-moistened several times throughout the day to maintain effectiveness.

Apply an antiseptic solution such as aluminum acetate (Burow's solution) or chlorhexidine to the affected area after each soaking. This helps prevent infection and promotes healing. Cover the toe with a light bandage to protect it during daily activities and keep the cotton in place.

What to Avoid During Home Treatment

Certain actions can worsen an ingrown toenail or lead to complications. Never attempt to cut out the ingrown portion of the nail yourself, as this almost always makes the problem worse and significantly increases infection risk. Avoid wearing tight shoes, high heels, or pointed-toe footwear during treatment, as these compress the toes and prevent healing.

Resist the temptation to pick at or tear the nail, even if a corner seems easy to remove. This creates jagged edges that are more likely to grow into the skin. Similarly, don't cut a V-notch in the center of the nail, as this common folk remedy has no scientific basis and doesn't prevent the nail edges from embedding in the skin.

When Should I See a Doctor for an Ingrown Toenail?

See a doctor if you have pus formation and significant pain, if symptoms don't improve after one week of home treatment, or if you have diabetes, poor circulation, or a weakened immune system. Seek immediate care if redness spreads beyond the toe, you develop fever, or the pain becomes severe.

While many ingrown toenails resolve with conservative home care, certain situations require professional medical evaluation and treatment. Recognizing when to seek care can prevent complications such as spreading infection, abscess formation, or in rare cases, bone infection (osteomyelitis).

The most obvious indication for medical care is the presence of infection. When pus accumulates around the nail, the body's immune response is struggling to contain the bacteria, and antibiotics or drainage may be needed. Significant infection can spread to surrounding tissues (cellulitis), which manifests as redness extending beyond the immediate toe area, increased warmth, and sometimes red streaks moving up the foot.

Pain that interferes with daily activities, prevents you from wearing any shoes, or keeps you awake at night suggests a level of severity that warrants professional evaluation. Similarly, if you've been diligently following home treatment measures for a week without any improvement, or if symptoms are getting worse despite treatment, a healthcare provider can offer more effective interventions.

High-Risk Groups

Certain medical conditions significantly increase the risk of complications from ingrown toenails and warrant prompt medical attention even for seemingly mild cases. People with diabetes should be particularly cautious, as diabetic neuropathy may mask pain and delay recognition of infection, while impaired blood flow delays healing and increases susceptibility to serious complications.

Individuals with peripheral vascular disease, peripheral artery disease, or other conditions affecting blood circulation to the feet should seek medical evaluation rather than attempting home treatment. Poor circulation impairs the body's ability to fight infection and heal wounds, turning minor problems into serious ones. Similarly, people with weakened immune systems due to conditions like HIV/AIDS, cancer treatment, or immunosuppressive medications are at elevated risk.

How Do Doctors Treat Ingrown Toenails?

Medical treatment options include draining infected tissue, partial nail removal, or complete removal of the ingrown nail portion combined with chemical or surgical ablation of the nail matrix to prevent regrowth. These procedures are typically performed under local anesthesia with minimal discomfort and high success rates exceeding 95%.

When conservative measures fail or infection has developed, healthcare providers have several effective treatment options. The appropriate treatment depends on the severity of the condition, presence of infection, and whether the ingrown toenail is a recurring problem. Most procedures can be performed in an office or clinic setting under local anesthesia.

For infected ingrown toenails, the first priority is treating the infection. If an abscess has formed, the healthcare provider will drain the pus to relieve pressure and pain. This may involve lifting the nail edge to access trapped pus or making a small incision in the nail fold. Antibiotics are prescribed when there is significant surrounding tissue infection (cellulitis) or in patients at high risk for complications.

The choice of procedure depends largely on whether this is a first occurrence or a recurrent problem. For first-time ingrown toenails without significant deformity, more conservative approaches may be tried first. For recurrent cases or when the nail has a pronounced curve that predisposes to repeated ingrowth, more definitive procedures that prevent the problem portion of the nail from regrowing are preferred.

Nail Avulsion (Partial Nail Removal)

Partial nail avulsion is the most common surgical treatment for ingrown toenails. After numbing the toe with local anesthesia, the healthcare provider separates the ingrown portion of the nail from the underlying nail bed and removes it. This immediately relieves pain and allows the infection to drain. The procedure takes only a few minutes and provides rapid relief.

When partial avulsion is performed alone, the nail will regrow over several months. However, because the underlying cause (the nail's shape and growth pattern) remains unchanged, recurrence rates are relatively high, around 30-50%. For this reason, partial avulsion is often combined with matrix ablation for a more permanent solution.

Matrix Ablation for Permanent Correction

To prevent the ingrown portion of the nail from regrowing, the nail matrix (the tissue at the base of the nail responsible for nail growth) can be destroyed. The most common method uses phenol, a chemical that destroys the matrix cells when applied to the nail matrix after partial nail avulsion. This chemical matrixectomy has success rates exceeding 95% with low recurrence rates.

Alternatively, the matrix can be surgically excised or destroyed using electrocautery or laser. These methods have similar success rates to phenol ablation. After matrix ablation, the removed portion of the nail will not regrow, resulting in a slightly narrower nail. Most patients find this cosmetically acceptable and prefer it to continued problems with ingrown nails.

Recovery After Surgical Treatment

Recovery from nail procedures is generally straightforward. Pain is usually well-controlled with over-the-counter pain medications and typically subsides significantly within a few days. The toe is kept bandaged and should be kept clean and dry. Soaking may be recommended starting a day or two after the procedure to promote healing.

Most people can resume normal activities within a day or two, though strenuous exercise and tight footwear should be avoided for one to two weeks. Complete healing typically takes 2-4 weeks. Complications are uncommon but can include infection, prolonged drainage, or, rarely, regrowth of the treated nail portion requiring repeat treatment.

How Can I Prevent Ingrown Toenails?

Prevent ingrown toenails by cutting nails straight across (not rounded), avoiding cutting too short, wearing properly fitted shoes with adequate toe room, and protecting feet from injury. Proper nail trimming technique is the single most important preventive measure.

Once you've experienced an ingrown toenail, taking steps to prevent recurrence becomes a priority. Fortunately, most ingrown toenails are preventable with proper foot care and attention to footwear. Understanding the causes helps you take targeted preventive measures.

The two most common causes of ingrown toenails are improper nail trimming and tight footwear. Addressing these factors significantly reduces your risk. Prevention is particularly important if you have naturally curved nails, as this anatomical variation predisposes to ingrown nails even with otherwise good foot care.

Proper Nail Trimming Technique

Correct nail trimming is the most important preventive measure. Use straight nail clippers or nail scissors designed for toenails rather than curved fingernail clippers. Cut the nail straight across, following the natural shape of the toe tip. The corners of the nail should extend slightly beyond the nail fold so they don't dig into the skin.

Avoid cutting nails too short, as this allows the skin of the nail fold to grow over the nail edge, trapping the nail as it grows. The nail edge should be visible above the skin when you look at your toe from the front. After cutting, use a nail file to smooth any sharp edges that might catch on socks or dig into skin.

If your toenails are thick or difficult to cut, soak your feet in warm water for 10-15 minutes before trimming. This softens the nails and makes them easier to cut cleanly. Never tear or rip toenails, as this creates jagged edges that are more likely to become ingrown.

Choosing Proper Footwear

Shoes that compress the toes force the nail edges into the surrounding skin, contributing to ingrown nail development. Choose shoes with a wide, deep toe box that allows your toes to move freely. When trying on shoes, ensure there's about a thumb's width of space between your longest toe and the end of the shoe.

Avoid high heels and pointed-toe shoes, especially for extended wear, as these push toes together and increase pressure on the nails. If your work requires dress shoes, consider styles with rounder toe boxes or bring comfortable shoes to change into when possible. Athletic shoes should be properly fitted and replaced when worn out, as compressed cushioning increases pressure on the feet.

Choose socks made of breathable materials that allow your toes room to move. Avoid tight socks or those with seams that press on the toes. Keeping feet dry also helps, as moisture can soften the skin and make it more susceptible to nail penetration.

Preventive Treatment for Recurrent Cases

If you frequently develop ingrown toenails despite proper nail care and footwear, you can try a preventive cotton wedge technique. Regularly place a small piece of cotton under the nail edges to keep them lifted away from the skin. This should be done daily after bathing, using clean cotton that is replaced each time.

A podiatrist or foot care specialist can assess whether you have anatomical factors contributing to recurrent ingrown nails, such as unusually curved nails or bone spurs that push tissue against the nail. In some cases, custom orthotics or professional nail care may be recommended. For severely curved nails that repeatedly become ingrown despite conservative measures, permanent surgical correction offers a definitive solution.

What is Paronychia and How Does It Differ from an Ingrown Toenail?

Paronychia is an infection of the skin fold surrounding the nail (the paronychium), while an ingrown toenail is a mechanical problem where the nail edge grows into the skin. These conditions often occur together because the wound created by an ingrown toenail provides an entry point for bacteria that cause paronychia.

Understanding the relationship between ingrown toenails and paronychia helps clarify why these conditions often occur together and why treatment approaches overlap. While they are distinct conditions with different underlying causes, the resulting symptoms can be very similar, and one frequently leads to the other.

An ingrown toenail is primarily a mechanical problem. The nail plate, due to its shape, improper trimming, or external pressure, physically grows into the soft tissue of the nail fold. This creates a wound that causes pain and inflammation even in the absence of infection. If bacteria don't enter the wound, it remains a sterile inflammatory condition.

Paronychia, in contrast, is an infection of the nail fold tissue. It can be caused by bacteria (acute paronychia) or fungi (chronic paronychia). While paronychia can develop independently from minor trauma, hangnails, or skin damage, it very commonly develops as a complication of ingrown toenails when bacteria enter through the wound created by the ingrown nail edge.

Acute vs. Chronic Paronychia

Acute paronychia develops rapidly, usually within one to two days, and is most commonly caused by bacterial infection, typically Staphylococcus aureus. It causes sudden onset of pain, redness, and swelling around the nail, with pus formation in many cases. This is the type of paronychia most associated with ingrown toenails and responds to drainage and antibiotics.

Chronic paronychia develops more gradually over weeks and is often caused by fungal organisms such as Candida. It is less commonly associated with ingrown toenails and more often occurs in people whose hands are frequently wet. Chronic paronychia causes nail fold swelling and tenderness with periodic flares but less dramatic acute symptoms.

Treatment of Paronychia

The treatment of paronychia depends on its cause and severity. Mild cases may respond to warm soaks and topical antiseptics, similar to early ingrown toenail treatment. More significant infections require drainage of any pus collection, which provides immediate pain relief and accelerates healing.

When paronychia occurs with an ingrown toenail, treating both conditions together is important. Simply draining the infection without addressing the ingrown nail will result in recurrence, as the nail will continue to wound the skin and provide an entry point for bacteria. Partial nail avulsion both removes the source of the wound and allows complete drainage of the infection.

Antibiotics are prescribed for paronychia when there is significant surrounding tissue infection, when the patient is immunocompromised, or when drainage alone doesn't resolve the infection. Oral antibiotics are more effective than topical antibiotics for established infections and are typically prescribed for 7-10 days.

What Complications Can Occur from Untreated Ingrown Toenails?

Untreated ingrown toenails can lead to paronychia (nail fold infection), cellulitis (spreading skin infection), abscess formation, chronic pain, and in rare severe cases, osteomyelitis (bone infection). Complications are more common and more serious in people with diabetes or poor circulation.

While most ingrown toenails are minor problems that resolve with appropriate treatment, neglected cases can lead to significant complications. Understanding potential complications emphasizes the importance of timely treatment and helps you recognize when an ingrown toenail is becoming a more serious problem.

The most common complication is secondary bacterial infection. As discussed, when bacteria enter the wound created by the ingrown nail, paronychia develops. Without treatment, this localized infection can progress to an abscess, a pocket of pus that requires drainage. Abscesses cause significant pain and swelling and may require surgical drainage.

Infection can spread beyond the nail fold into surrounding tissue, causing cellulitis. This presents as expanding redness, warmth, and swelling that extends beyond the immediate toe area. Cellulitis is a more serious infection requiring oral or even intravenous antibiotics. You may feel generally unwell and develop fever. Red streaks extending up the foot indicate lymphangitis, spread of infection along lymphatic channels, which requires urgent treatment.

Long-Term Complications

Repeated or chronic ingrown toenails can lead to permanent changes in the nail and surrounding tissue. Chronic inflammation may cause the nail to become thickened, discolored, or deformed. Granulation tissue (overgrowth of inflamed tissue) may develop over the nail edge, further complicating treatment and sometimes requiring surgical removal.

In very rare cases, severe untreated infections can spread to the underlying bone, causing osteomyelitis. This is a serious infection requiring prolonged antibiotic treatment and sometimes surgical debridement of infected bone. Osteomyelitis is most likely to occur in people with diabetes or severe peripheral vascular disease who have delayed recognition of infection.

Complications in High-Risk Patients

People with diabetes face significantly higher risks from ingrown toenails and their complications. Diabetic neuropathy can mask pain, allowing infections to progress before they're noticed. Impaired circulation delays healing and reduces the body's ability to fight infection. A seemingly minor ingrown toenail in a diabetic patient can rapidly progress to serious infection, tissue death, and in worst cases, may contribute to the need for toe or foot amputation.

Similarly, people with peripheral vascular disease, chronic kidney disease requiring dialysis, or immunosuppression from medications or conditions like HIV/AIDS are at elevated risk. These patients should seek professional care for ingrown toenails rather than attempting home treatment, and should regularly inspect their feet for early signs of problems.