Ingrown Toenails: Causes, Treatment Options, and Prevention

What Is an Ingrown Toenail?

Onychocryptosis occurs when the nail edge grows into the surrounding skin (lateral nail fold), causing pain, inflammation, and potential infection. The great toe is most commonly affected.

Causes

• Improper trimming: Cutting too short, rounding corners, or tearing the nail.
• Footwear: Tight, narrow, or pointed toe boxes; high heels.
• Trauma: Stubbing, dropping objects, repetitive pressure (running, soccer).
• Anatomy: Curved or thick nails (genetic), wide nail plate.
• Medical conditions: Diabetes (neuropathy, poor healing), obesity, edema, fungal infection, hyperhidrosis.
• Biomechanics: Overpronation, hallux valgus.

Symptoms

• Pain and tenderness along the nail margin.
• Redness, swelling, warmth.
• Drainage (pus indicates infection).
• Granulation tissue (proud flesh).
• Difficulty wearing shoes or walking.

Staging

• Stage 1: Erythema, edema, pain on pressure.
• Stage 2: Infection (purulence), increased pain and swelling.
• Stage 3: Chronic granulation tissue, hypertrophy of the nail fold.

Treatment

Conservative (Stage 1, mild Stage 2)

• Warm soaks (Epsom salt) 15–20 minutes, 3–4 times daily.
• Cotton or dental floss wedge under the nail edge to gently lift it.
• Topical antibiotic (e.g., mupirocin) if signs of infection.
• Proper trimming: straight across, not too short.
• Open-toe or loose-fitting shoes.

Surgical (Stage 2–3, recurrent, diabetic)

• Partial nail avulsion with phenol matrixectomy (gold standard): Remove the offending nail border; apply phenol (88%) to the germinal matrix for a 95%+ permanent cure. Performed under local anesthesia with minimal downtime.
• Total nail avulsion (rarely needed).
• Wedge resection of soft tissue — older technique.

Prevention

• Trim nails straight across; file sharp corners; don't cut too short.
• Wear shoes with adequate toe box (width and depth).
• Protect feet from trauma.
• Manage diabetes, edema, hyperhidrosis.
• Regular podiatry visits if high-risk (diabetes, peripheral arterial disease, neuropathy).

When to See a Podiatrist/Doctor

• Diabetes, peripheral arterial disease, immunocompromised — immediately.
• Signs of infection (pus, spreading redness, fever).
• Severe pain, recurrent, not improving in 3–5 days with conservative care.

Don't attempt "bathroom surgery"—it risks serious infection. Professional care is quick, effective, and usually permanent.