In short: an ingrown toenail (onychocryptosis) happens when the edge of the nail plate presses into and then pierces the skin beside it, which is why the toe becomes tender, red and sometimes infected. In most cases a podiatrist can remove the small offending spike of nail at your first appointment, which brings relief straight away and is usually very comfortable. For toes that keep coming back, a partial nail avulsion with phenolisation, done under local anaesthetic in our clinic, narrows that edge of the nail for good, and you walk out the same day.
What an ingrown toenail actually is
The nail plate sits in a groove of skin on each side, called the sulcus. An ingrown toenail develops when a sharp edge or splinter of nail, sometimes only a millimetre or two long, digs sideways into the wall of that groove instead of growing forward over it. Once the skin is broken, the body treats the nail as a foreign object, and that is what produces the throbbing, the redness and the tenderness when a bedsheet or a shoe touches the toe.
The big toe is by far the most common site, though any toe can be affected. The pattern is usually predictable: pressure and tenderness at one corner first, then swelling and warmth, then a bead of clear or yellow fluid. Left long enough, the body grows a lump of soft, fleshy, easily bleeding tissue over the nail edge (hypergranulation), which is a sign the toe has been irritated for some time rather than a sign of anything sinister. Pain that keeps you awake, spreading redness up the toe or foot, or a fever means you should be seen promptly.
Why toenails grow into the skin
It is rarely one single thing. The usual contributors are:
- Nail shape. Some people inherit a strongly curved or involuted nail that pinches the skin as it grows. If your parents had ingrown toenails, there is a fair chance you will too.
- How the nails are cut. Cutting too short, or following the curve down into the corners, leaves a spike buried in the sulcus where you cannot see it.
- Footwear and socks. Shoes that are short, narrow or shallow through the toe box press the skin onto the nail edge all day. Tight socks and hosiery do the same thing.
- Trauma. Stubbing the toe, dropping something on it, repeated braking in football boots or running downhill can all change the way the nail grows out.
- Sweaty feet. Moisture softens the skin around the nail, which makes it far easier for a nail edge to breach it. This is one reason ingrown toenails are so common in teenagers and in people who train regularly.
- Picking and tearing. Pulling a nail off rather than cutting it very often leaves a ragged edge behind.
Why bathroom surgery makes it worse
Almost everyone tries to fix it themselves first. The problem is that the painful part is the deepest part, so digging at the corner with clippers or scissors usually snaps the nail off short and leaves the actual offending spicule still buried in the skin, now with a fresh wound over it. That is the classic pattern we see: a toe that feels better for two days and then flares worse than before.
Two other home remedies are worth naming. Packing cotton wool under the nail edge is uncomfortable, tends to hold moisture against broken skin and does nothing about the spike itself. And cutting a V-shaped notch in the middle of the nail does not draw the sides inwards. Nails grow forward from the base, not sideways from the tip.
What happens at your appointment
We start by looking at the whole nail, not just the sore corner, and check the skin, the circulation and the sensation in the toe. Then, using sterile instruments, we gently free and remove the piece of nail that is pressing into the skin, clear the groove and file the remaining edge smooth so nothing sharp is left behind.
People are often surprised by this part. Because we are removing the thing causing the pain rather than cutting into healthy tissue, conservative treatment is usually very comfortable and the relief is immediate. If the toe is badly inflamed, or there is a lot of granulation tissue, we can numb the toe with local anaesthetic first so the area can be cleared properly and comfortably.
The toe is then dressed, and we give you clear instructions for the next few days, along with practical advice on cutting technique and footwear so the same corner does not recur. If there is a spreading infection that needs oral antibiotics, we will tell you and coordinate with your GP.
When nail surgery is the answer
If the same edge has come back several times, or the nail is so curved that it will always dig in, treating the symptom repeatedly is not a fair deal. Partial nail avulsion with phenolisation is the definitive option, and it is a straightforward in-clinic procedure.
The toe is fully numbed with local anaesthetic, which our podiatrists are registered and qualified to administer. We remove only the narrow offending strip along one or both sides, then apply phenol to the nail matrix underneath so that strip does not grow back. The result is a narrower nail that still looks like a normal toenail to anyone glancing at your foot. There is no need for a hospital or a general anaesthetic, no stitches, and you walk out on the same foot you walked in on, usually straight after the appointment.
You do not need a referral to have this done with us, unless you are a DVA Gold Card holder or the injury is a WorkCover matter. Most private health funds pay a benefit toward podiatry, and we have HICAPS at every clinic so your rebate is processed on the spot.
Aftercare, healing and diabetes
After nail surgery the toe is dressed in the clinic and kept dry for the first day or two. We review you shortly afterwards to change the dressing and check the site, then set a simple redressing routine, usually a saltwater soak, a clean dressing and a roomy shoe, until the area has closed over. Most people are comfortable enough to go back to work or school the next day. Sport, swimming and closed football boots wait until we have cleared the toe, and we keep reviewing it until it has fully settled rather than sending you off with a guess.
If you have diabetes, please do not treat an ingrown toenail yourself. Reduced sensation can hide how deep the problem has gone, and reduced circulation slows healing, so a small nail edge can become a much bigger wound problem than it would in anyone else. Book in early, mention your diabetes when you call, and we will assess the circulation and nerve supply as part of your diabetic foot care. If you have a chronic condition such as diabetes, arthritis or vascular disease, your GP may be able to arrange an Enhanced Primary Care plan for a Medicare rebate on podiatry.
The same caution applies to children and teenagers, who often hide a sore toe until it is badly infected. We treat plenty of them, and the approach is gentle and unhurried. See children’s podiatry for how we work with younger patients.
Common questions
Does ingrown toenail treatment hurt?
Conservative removal of the offending nail edge is usually very comfortable, because we are taking away the object causing the pain rather than cutting healthy skin. Where the toe is very inflamed, or when nail surgery is planned, we numb the toe with local anaesthetic first so the procedure itself is not felt.
Do I need a referral to be seen?
No. You can book directly with us. The only exceptions are DVA Gold Card holders and WorkCover patients, who do need a referral. If you have a chronic condition, ask your GP about an Enhanced Primary Care plan for a Medicare rebate.
Will the nail grow back after nail surgery?
Only the narrow strip we treat with phenol is intended not to regrow, and that part of the change is permanent. The rest of the nail keeps growing normally, so what you end up with is a slightly narrower toenail rather than a missing one.
How long is the recovery, and when can I get back to sport?
You walk out of the clinic the same day and most people manage work or school the next day in a roomy shoe. The nail edge takes a few weeks to close over and settle, and we review the toe along the way. We will give you a clear point to return to running, boots and swimming rather than leaving you guessing.
Can I claim the appointment on my health fund?
Yes, if your policy includes podiatry. We have HICAPS at every clinic, so the rebate is processed while you are with us and you only pay the gap. We accept Visa, Mastercard and EFTPOS. More detail is on our FAQ page.
My toe is already infected. Should I still come in?
Yes, and sooner rather than later. Removing the nail edge is what allows an infected toe to drain and heal, so treating the infection without addressing the nail rarely works for long. If oral antibiotics are also needed we will tell you and work with your GP.
This page is general information, not personal medical advice. Reviewed by Gideon Poratt, Principal Podiatrist (B.App.Sc (Pod), M.A.Pod.A), a member of the Australian Podiatry Association. Please book an assessment for advice specific to your feet.