Elite Foot & Ankle

Ingrown Toenail

Ingrown toenail is a condition that most commonly affects the big toe. This condition usually results when pressure from improper shoe wear and improper care of the toenails leads to pain and overgrowth of the tissue at the side of the nail.

When a toenail is ingrown, it is curved and grows into the skin, usually at the nail borders (the sides of the nail). This “digging in” of the nail irritates the skin, often creating pain, redness, swelling, and warmth in the toe.

If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odor. However, even if the toe isn’t painful, red, swollen, or warm, a nail that curves downward into the skin can progress to an infection.

Causes of ingrown toenails

  • Heredity.  Many people have the tendency towards getting ingrown toenails through heredity.
  • Trauma.  Sometimes an ingrown toenail is the result of trauma, such as stubbing your toe, having an object fall on your toe, or engaging in activities that involve repeated pressure on the toes, such as kicking or running.
  • Improper trimming. The most common cause of ingrown toenails is cutting your nails too short. This encourages the skin next to the nail to fold over the nail.
  • Improperly sized footwear. Ingrown toenails can result from wearing socks and shoes that are tight or short.
  • Nail Conditions. Ingrown toenails can be caused by nail problems, such as fungal infections or losing a nail due to trauma.

The nail groove begins to disappear. The chronic pressure of the nail edge rubbing against the nail groove causes irritation and swelling of the surrounding skin. If the condition continues overgrowth of the tissue leads to pain and swelling and possible infection.

Improper trimming of the toenail can also cause problems. If the corner of the toenail is not allowed to grow out past the skin at the end of the nail groove, it may dig into the skin. This makes the pressure from the shoe even more painful.

Treatments for Ingrown Toenails

Sometimes initial treatment for ingrown toenails can be safely performed at home. However, home treatment is strongly discouraged if an infection is suspected, or for those who have medical conditions that put feet at high risk, such as diabetes, nerve damage in the foot, or poor circulation.

Nonsurgical Treatment

If caught early, nonsurgical treatment may suffice. Pressure on the toe should be reduced to a minimum with sandals or simply not wearing a shoe for several days. The temptation to trim the corner of the toenail off should be avoided. This can lead to a worse condition where the toenail forms a fish hook deformity that further grows into the nail groove. The goal of nonsurgical treatment is to allow the toenail to grow out to the end of the toe beyond the nail groove. Intermittent soaks in a warm saline solution may be suggested. If the area is infected, antibiotics may be necessary to eliminate the infection.

Once the condition has resolved, shoes should be found that do not put too much pressure on the big toe. The nails should be trimmed straight across and never below the end of the nail groove.


If the condition has resulted in permanent hypertrophy of the tissue surrounding the nail margin, surgery may be required to treat the condition.

Wedge Resection

In mild cases, removal of a portion of the hypertrophied tissue may reduce the pressure and irritation. In this procedure, a wedge of tissue is removed and the healing process allows the nail groove to reform itself.

Partial Nail and Matrix Removal

More severe cases may require removal of a portion of the toenail and the germinal matrix that produces that portion of the nail.

Nail and Matrix Ablation

Finally, in cases of severe deformity, the entire nail and its germinal matrix may need to be removed. This is called a nail ablation. No new toenail will grow back. This should be done only as last resort.