Ingrown toenail

Also known as onychocryptosis

An ingrown toenail occurs when one or both sides of your toenail grow into the surrounding skin. This can cause pain, swelling and infection.

Key points about ingrown toenail

  1. This is a common problem that particularly affects teenagers and young adults, and people who are overweight.
  2. It usually affects your big toe but can also happen on other toes.
  3. Causes of an ingrown toenail include badly cut toenails, poorly fitted shoes, tight socks, fungal nail infections, foot injuries, sweaty feet or genetics.
  4. Symptoms include pain and redness at the nail edges of your affected toe. 
  5. Treatment ranges from self-care measures to minor surgery to remove your whole nail or to cut away part of your nail.
  6. You can often prevent an ingrown toenail by cutting your nails correctly and not wearing poorly fitted shoes and socks.
See your doctor urgently if you experience the following:
  • your pain gets worse or self-care measures are not helping
  • your toe becomes more painful and swollen and pus can be seen
  • you have a fever (high temperature) and feel unwell
  • the redness on your toe has spread into your foot or leg
  • you have diabetes and an ingrown toenail.

What are the causes of an ingrown toenail?

An ingrown toenail can occur due to a number of causes. 

  • Badly cut toenails – cutting  your toenails too short or into the corners can break the natural skin barrier. This increases the risk of infection and allows your skin to fold over the nail edge and your nail to grow into it. 
  • Increased pressure from tight shoes, socks or tights.
  • Foot injuries – ingrown toenails can appear after injuring your toe.
  • Sweaty feet.
  • Fungal nail infections can cause a thickened or widened toenail.
  • Genetics and natural toenail shape – toenails that are more curved or fan-shaped are more likely to press into the sides.
  • Medicines such as isotretinoin.

What are the symptoms of an ingrown toenail?

Typical symptoms include: 

  • a red and painful edge of the skin around your toenail
  • pain in that area when wearing shoes due to pressure on your toe
  • a raised area along the toenail edge from an overgrowth of skin.

If your ingrown toenail gets infected, your toe can become more swollen and the pain and redness can get worse, and sometimes blood or pus can be seen.

How is an ingrown toenail diagnosed? 

Your doctor will ask you questions about your symptoms and examine your toe to see if it is infected. Usually no tests are needed to diagnose an ingrown toenail, other than a possible swab test. 

How is an ingrown toenail treated? 

Treatment of an ingrown toenail consists of self-care measures and may involve antibiotics or minor surgery. 

Your GP will first recommend self-care measures to help relieve your symptoms, such as:

  • soaking your foot in warm water 3 to 4 times a day for a few days – this will help soften the skin around your toe and stop your nail growing into it
  • adding a mild antiseptic to the soaking water or adding cider vinegar (1 quarter cup per basin)
  • keeping your foot dry at other times
  • wearing well-fitting and comfortable shoes
  • taking pain relief medicines such as paracetamol or ibuprofen to relieve your pain – check with your GP or pharmacist whether you can take them
  • not cutting or picking at your toenail – instead allowing it to grow out so it is easier to cut it straight across
  • if pus can be seen, swabbing that area with antiseptic or methylated spirit to clear away the pus.

There are many devices available from your pharmacy (eg, Scholl’s toe protector) or online. These are designed to ease pressure on the affected toe. They are inexpensive.

If your symptoms don’t improve after self-care measures, or if your ingrown toenail is infected, your GP may prescribe antibiotics. Any material oozing from that area may be tested in the laboratory to help your GP prescribe the correct antibiotic.

Your GP or podiatrist may also perform minor surgery to remove your whole nail or cut away part of your nail. This procedure can be done in their consulting room using local anaesthetic. Discuss these options with your GP.

How can I prevent an ingrown toenail? 

You can help prevent an ingrown toenail with the following measures: 

  • Take care when cutting your toenails. Cut straight across, not too short and not into the corners or edges.
  • Wear comfortable, well-fitting shoes or sandals.
  • At work, wear steel-booted footwear, where appropriate.
  • Avoid tight socks and change them every day, or as soon as your sport or exercise is over. 
  • Wash your feet every day, dry well and apply moisturiser to dry skin. 

What support is available with an ingrown toenail? 

Other than your GP, a podiatrist can help assess your foot and advise the best treatment options for you. Find a local podiatrist Podiatry NZ

Learn more 

Ingrown toenail HealthInfo Canterbury, NZ
Ingrown toenails Podiatry NZ
Ingrown toenail NHS, UK

References

  1. Ingrown toenail DermNet, NZ
  2. Ingrown toenail Auckland Regional HealthPathways, NZ
  3. Ingrown toenails Patient Info, UK

Reviewed by

After 45 years of GP experience, and 8 years as an examiner and practice assessor, Dr Bryan Frost has completed a Diploma in Editing and is pursuing a new career. He also has a Diploma in Health Administration, with honours in management, and has also completed a paper in Health Care Law.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Bryan Frost, FRNZCGP, Morrinsville Last reviewed: 23 Feb 2021