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Ingrown Toenail

Topic Overview

What is an ingrown toenail?

An ingrown toenail is a toenail that has grown into the skin instead of over it. This usually happens to the big toe, but it can also happen to other toes. An ingrown toenail can get infected. It may be painful, red, and swollen, and it may drain pus. See a picture of an ingrown toenail.

Anyone can get an ingrown toenail, but adults get them more than children do. People who have curved or thick nails are more likely to get an ingrown toenail. This is more common in older adults.

What causes an ingrown toenail?

An ingrown toenail can have a number of different causes. Cutting your toenail too short or rounding the edge of the nail can cause it to grow into the skin. Wearing shoes or socks that don't fit well can also cause an ingrown toenail. If your shoes are too tight, they might press the nail into the toe and cause it to grow into the skin.

You can get an ingrown toenail if you hurt your toe, such as stubbing it. This can cause the nail to grow inward. Repeating an activity that injuries the nail, such as kicking a soccer ball, can also cause an ingrown nail.

What are the symptoms?

The main symptom of an ingrown toenail is the pain from the nail growing into the skin instead of over it. If the ingrown toenail gets infected, it might be swollen or red, and it might drain pus. The area around the ingrown toenail is often painful.

How is an ingrown toenail diagnosed?

Your doctor will do a physical examination to diagnose an ingrown toenail. He or she will look at your toe where the nail has grown into the skin.

How is it treated?

You can try the following steps at home to relieve the pain caused by your ingrown toenail and help the nail to grow out naturally:

  • Soak your sore toe in warm water for 15 minutes 2 to 3 times each day.
  • Wedge a small piece of wet cotton, such as part of a cotton ball, under the corner of your ingrown nail. This will help lift the nail off of the skin.
  • Soak your toe and change the piece of cotton each day until the nail grows out and can be trimmed.
  • Do not use a sharp object like manicure scissors to dig under your nail, because the toe might get infected.
  • Do not try to use a needle to drain the pus from your toe. This could make the infection worse.
  • While your ingrown toenail is healing, wear comfortable shoes or sandals that do not press on your toe.

Use these home treatment steps for 3 days. If they do not help, you might need to see your doctor. Be sure to see a doctor if your toe gets infected. Your toe might be infected if it hurts more than it did before you tried the home treatment. Call your doctor if your toe is red, warm, swollen, or drains pus, or if there are red streaks leading from your toe.

Your doctor might give you antibiotics. If your toenail is very ingrown, your doctor might suggest minor surgery to remove all or part of the ingrown nail. He or she may refer you to a podiatrist.

During this surgery, the doctor will numb your toe. Then he or she will cut the edge of the ingrown toenail and pull out the piece of nail. To prevent the nail from growing into the skin again, your doctor might destroy all or part of the nail root. This is called ablation. If your doctor removes all or part of your nail but does not destroy the root, it will begin to grow back within a few months.

After the surgery it is important to take care of your toe so that it can heal. Your doctor will give you specific instructions to follow. He or she may tell you to:

  • Soak your toe in warm water for 15 minutes 2 to 3 times each day.
  • Rub antibiotic ointment 2 times each day on the toe where the nail was removed.
  • Wear a bandage on your toe.
  • Wear loose-fitting shoes that don't press on the toe where the nail was removed.
  • Take pain medicine if your toe hurts. Non-steroidal anti-inflammatory drugs (NSAIDs), including ASA (such as Bayer), ibuprofen (such as Advil), or naproxen (such as Aleve), might help your toe feel better. Do not give ASA to anyone younger than 20 because of the risk of Reye syndrome.

How can ingrown toenails be prevented?

You may be able to prevent ingrown toenails by wearing roomy and comfortable shoes and socks that do not press on your toes. If you work in a place where your toe might get hurt, wear sturdy shoes such as steel-toed boots to protect your toes.

Be sure to trim your toenails properly. You can do this by cutting your toenail straight across, not curved. Make sure you do not cut your toenail too short. You can also leave your toenail a little longer at the corners to help it grow over the skin.

If you have diabetes or peripheral arterial disease, talk with your doctor before you trim your own toenails. People with diabetes have a hard time feeling their toes and might cut themselves without realizing it. Peripheral arterial disease can cause toes to be very painful.

Many hospitals and health care centres have foot care clinics, where someone can help you trim your toenails. Ask your doctor to recommend a foot care clinic near your home.

References

Other Works Consulted

  • Frey C (2005). Ingrown toenail section of Foot and ankle. In LY Griffin, ed., Essentials of Musculoskeletal Care, 3rd ed., pp. 651–654. Rosemont, IL: American Academy of Orthopaedic Surgeons.
  • Mann JA, et al. (2003). Disorders of the toenails section of Foot and ankle surgery. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 3rd ed., pp. 483–485. New York: McGraw-Hill.
  • Melio FR (2004). Onychocryptosis (ingrown toenail) section of Soft tissue problems of the foot. In JE Tintinalli et al., eds., Emergency Medicine: A Comprehensive Study Guide, 6th ed., p. 1802. New York: McGraw-Hill.

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer H. Michael O'Connor, MD - Emergency Medicine
Last Revised December 10, 2012
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