Ingrown toenail

Definition

An ingrown toenail occurs when the edge of the nail grows into the skin of the toe.

Alternative Names

Onychocryptosis; Unguis incarnates; Surgical nail avulsion; Matrix excision; Ingrown toenail removal

Causes

An ingrown toenail can result from a number of things. Poorly fitting shoes and toenails that are not properly trimmed are the most common causes. The skin along the edge of a toenail may become red and infected. The great toe is affected most often, but any toenail can become ingrown.

An ingrown toenail may occur when extra pressure is placed on your toe. This pressure is caused by shoes that are too tight or fit poorly. If you walk often or play sports, a shoe that is even a little tight can cause this problem. Deformities of the foot or toes can also place extra pressure on the toe.

Nails that are not trimmed properly can also cause ingrown toenails:

  • Toenails that are trimmed too short, or if the edges are rounded rather than cut straight across may cause the nail to curl and grow into the skin.
  • Poor eyesight, inability to reach the toes easily, or having thick nails can make it hard to properly trim nails.
  • Picking or tearing at the corners of the nails can also cause an ingrown toenail.

Some people are born with nails that are curved and grow into the skin. Others have toenails that are too large for their toes. Stubbing your toe or other injuries can also lead to an ingrown toenail.

Symptoms

There may be pain, redness, and swelling around the nail.

Exams and Tests

Your health care provider will examine your toenail and ask about your symptoms.

Tests or x-rays aren't usually needed.

Treatment

If you have diabetes, nerve problems in the leg or foot, poor blood circulation to your foot, or an infection around the nail, see your provider right away. Don't try to treat an ingrown nail at home.

Otherwise, to treat an ingrown nail at home:

  • Soak the foot in warm water 3 to 4 times a day if possible. After soaking, keep the toe dry.
  • Gently massage over the inflamed skin.
  • Place a small piece of cotton or dental floss under the nail. Wet the cotton or floss with water or antiseptic.

When trimming your toenails:

  • Briefly soak your foot in warm water to soften the nails.
  • Use a clean, sharp trimmer.
  • Trim toenails straight across the top. Do not taper or round the corners or trim too short.
  • Do not try to cut out the ingrown portion of the nail yourself. This will only make the problem worse.

Consider wearing sandals until the problem goes away. Over-the-counter medicine that is applied to the ingrown toenail may help with the pain, but it does not treat the problem.

If this doesn't work and the ingrown nail gets worse, see your provider or a foot specialist (podiatrist).

If the ingrown nail doesn't heal or keeps coming back, your provider may remove part of the nail:

  • Numbing medicine is first injected into the toe.
  • The ingrown part of the nail is removed. This procedure is called a partial nail avulsion.
  • It takes 2 to 4 months for the nail to regrow.

If the toe is infected, your provider may prescribe antibiotics.

After the procedure, follow any instructions for helping your nail heal.

Outlook (Prognosis)

Treatment usually controls the infection and relieves pain. The condition is likely to return if you don't practice good foot care.

This condition may become serious in people with diabetes, poor blood circulation, and nerve problems.

Possible Complications

In severe cases, the infection can spread through the toe and into the bone.

When to Contact a Medical Professional

Contact your provider if you:

  • Are not able to treat an ingrown toenail at home
  • Have severe pain, redness, swelling, or fever
  • Have diabetes, nerve damage in the leg or foot, poor circulation to your foot, or an infection around the nail

Prevention

Wear shoes that fit properly. Shoes that you wear every day should have plenty of room around your toes. Shoes that you wear for walking briskly or for playing sports should also have plenty of room, but not be too loose.

When trimming your toenails:

  • Briefly soak your foot in warm water to soften the nail.
  • Use a clean, sharp nail trimmer.
  • Trim toenails straight across the top. Do not taper or round the corners or trim too short.
  • Do not pick or tear at the nails.

Keep your feet clean and dry. People with diabetes should have routine foot exams and nail care.

References

Dinulos JGH. Nail diseases. In: Dinulos JGH, ed. Habif's Clinical Dermatology: A Color Guide in Diagnosis and Therapy. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 25.

Grear BJ. Disorders of nails. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 88.

Marks JG, Miller JJ. Nail disorders. In: Marks JG, Miller JJ, eds. Lookingbill and Marks' Principles of Dermatology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 21.

Review Date: 4/27/2023
Reviewed By: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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