Ingrown toenails

If you have an ingrown toenail, you will most likely experience some pain, which can become worse over time. It may feel like there is a tight and/or hot sensation in the affected area, and your toe will look redder, along with some potential swelling. There are some symptoms that you'll notice during the early stages of having an ingrown toenail, while others come later on due to infection.

Early symptoms of ingrown toenail

• Skin next to your toenail is harder, swollen, or tender
• Pain when pressure is put on your affected toe
• Fluid building up around your toe
• End of your toenail curving downwards into your toe

Symptoms of infection due to ingrown toenail

• Red, swollen skin
• Pain
• Bleeding at the site of your toenail digging into your skin
• Oozing pus
• Overgrowth of skin around the ingrown toenail
• Bad smell coming from your affected toe

There are a number of reasons why you might have an ingrown toenail, including:

Improper trimming

The most common cause of an ingrown toenail is cutting your toenails in the wrong way. Cutting them too short, for example, will encourage the skin next your toenail to fold over the toenail, which means that it grows down into your skin. You might also cut your toenails so that the nail curves in line with the shape of your toe. Trimming your toenail in this way may cause your toenail to grow into the skin, given how your nail will now curl down due to its curved shape.

Trauma

Your ingrown toenail may be a result of impact trauma, such as stubbing your toe, having your toe stepped on, or an object falling on your toe.

Footwear

Often, ingrown toenails occur when you wear footwear - socks and/or shoes - that is too tight or short, such as high heels, which puts repeated pressure on your toenail and causes it to grow down into your skin.

Certain sports and activities

If you use your feet extensively during athletic activities, you may be more prone to developing an ingrown toenail. This is because kicking an object for long periods of time, or doing any other activity where you put pressure on your feet, puts pressure on your toenails and increases the risk of them becoming ingrown.

Nail conditions

You might have a condition in your toenail that causes it to bend, such as a fungal infection or paronychia (infection of the skin around your toenail).

Heredity

It is possible that ingrown toenails can be caused by genetics. In some cases, you might be born with a toenail that is too big for your toe, which will naturally cause the edge of the toenail to grow down into your skin.

Old age

Old age may also be a contributing factor to an ingrown toenail. Your toenails become thicker over time, and this increased thickness means there is a greater chance of the toenail digging into the surrounding skin.

There are some lifestyle changes you can make to reduce your chances of developing an ingrown toenail in the future, such as:

• Trim your toenails straight, rather than in line with the curve of your toe, to ensure the edge of your toenail does not grow downwards into your skin
• Avoid cutting your toenails too short
• Take care to wear shoes and socks that aren't too small or tight
• If you work in hazardous conditions where something might fall on your foot, wear steel-toe boots
• If your big toenail is already very curved and/or thick, please see your consultant, who may recommend surgery to correct the shape of your toenail

At your initial consultation, your consultant will ask about your symptoms and any past toenail issues, along with checking whether you have any conditions that might have contributed to your ingrown toenail, such as diabetes, nerve issues, or issues with circulation.

Your consultant should be able to diagnose your ingrown toenail by inspecting it, checking for any swelling, redness, or tenderness in the affected area, as well as seeing if there is skin growing over your toenail. If your toenail fits these criteria, they will be able to confirm that you have an ingrown toenail.

In cases where your toe is infected, your consultant may take a sample of pus to confirm the type of infection. They might also order an X-ray, which allows them to see how deep your toenail has grown into your surrounding skin. It can also show them if your ingrown toenail was caused by an injury.

If your ingrown toenail is particularly severe, and more conservative measures like medications and home treatments don't work, your consultant may recommend surgery.

Usually, an ingrown toenail can be treated without surgery. Your consultant will recommend a series of treatments that you can safely carry out at home. The only time when your consultant will suggest medical intervention instead (medication and/or surgery) is when your ingrown toenail has become infected, or if you have medical conditions that may put your feet at risk, such as poor circulation, nerve damage, or diabetes.

Non-surgical treatment for ingrown toenails

There are various non-surgical, alternative treatment options you can use to treat an ingrown toenail, including:

Soaking your toe

The most common home treatment for ingrown toenails is soaking your affected foot in warm salt water. We recommend that you soak your toe four times a day for 20 to 30 minutes at a time. To do this, get a bucket of warm water, or fill your bathtub high enough so that you can immerse your toe. Add two teaspoons of Epsom salt (you can buy this at your local drugstore or grocery store). Regular table salt also works fine as well. Make sure you keep your foot completely dry in between each soak.

Use a cotton ball

If you have a slightly ingrown toenail, your consultant may recommend gently lifting your ingrowing nail and placing a cotton ball dipped in olive oil underneath the edge of your toenail. Doing this separates your toenail from your skin and supports growth above the edge of your skin, thereby relieving the pressure.

Change your footwear

Wearing tight shoes, or shoes that are too small, can lead to an ingrown toenail and/or make the condition worse. So, to alleviate your symptoms, your consultant will likely recommend that you wear wider, comfier footwear that doesn't press against the edge of the affected toe.

You should try these home treatments for one to two weeks. If the pain becomes worse and begins to restrict what you do during the day, and/or your ingrown toenail develops signs of infection, you may require surgery. Please also avoid making any attempt to remove a part of your ingrown toenail at home, as this may lead to further complications.

Surgical treatment for ingrown toenails

If your consultant decides that your ingrown toenail requires surgery, they shall pencil you in for either a partial nail removal procedure or total nail removal (also known as a matrixectomy). Both treatments are carried out under local anaesthetic, which means your surgeon will numb the toe with an injection and you won't feel a thing - nor will you see the surgery taking place. The procedure only takes around 15 to 20 minutes.

Partial nail removal

Your surgeon will start by placing a constricting band around the toe to reduce blood flow, ahead of administering the local anaesthetic, after which they will gently lift the ingrown part of the nail out from under the edge of the skin. A straight line is then cut from the piece of nail that has grown into your skin, starting at the tip and down to the root, allowing them to completely remove this portion of your toenail.

Having successfully removed the problematic part of your toenail, your surgeon will treat the base of your nail by dipping cotton swabs in a special chemical solution, which is then held against the base for a couple of seconds. Doing this prevents the ingrown toenail from coming back again. Once your surgeon has finished, they will remove the constricting band and wrap your toe in a bandage.

Total nail removal (matrixectomy)

This procedure is used when your ingrown toenail is caused by thickening, and follows similar steps to partial nail removal. The only key difference is that, rather than cutting a straight line through your nail, your surgeon will instead use a specialised instrument that carefully slips out the curved portion of your nail and its growth plate. The area where the growth plate was removed will then be treated with a special chemical (the same one as used in partial nail removal) to eliminate any remaining growth tissues, making it certain that the toenail won't grow back in the same damaging way again.

Recovering from ingrown toenail removal surgery

This is not a major surgery, so you'll be able to go home on the same day. You may be given crutches to help you keep weight off your foot. Your consultant will encourage you to rest for a couple of days with your foot elevated and iced to speed up the healing process and reduce any swelling. Generally, most people don't experience much discomfort, but we will provide pain relief if needed.

For the first couple of days, you'll be advised to avoid movement as much as possible and wear open-toe shoes. At the 48-hour mark, you will have a follow-up appointment to have your bandage will be removed and replaced with lighter dressings - at which point you'll be able to wear normal shoes. You should be able to make a return to work after a day or two, unless your job is highly physical, in which case you may need to take a little more time. You can drive almost immediately after the treatment.

If you had a partial nail removal procedure, it may take a few months for that portion of your toenail to grow back. For total nail removal, the process is more like a year.

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations to fit your schedule
• The autonomy to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans adapted to your particular needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private cosy ensuite rooms as standards and delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about ingrown toenails and how we can help, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in November 2022. Next review due November 2025.

1. Ingrown toenails: why do they happen?, Healthline
2. Ingrown toenails, Teens Health
3. Ingrown toenail, NHS
4. Partial nail removal, Arizona Foot
5. What is a matrixectomy and why do I need one?, Gentle Foot Care Clinic