Ingrown Toenails

Ingrown toenails regularly cause irritation, pain, inflammation, and often result in infection, which we can help from reoccuring.

Ingrown Toenails

Ingrown toenails regularly cause irritation, pain, inflammation, and often result in infection, which we can help from reoccuring.

Ingrown toenails are a common condition that can occur when the edge or corner of a toenail grows into the surrounding skin instead of growing straight out. This can lead to pain, discomfort, and swelling. They can occur on any toenail, but most commonly affect the big toe.

Most commonly presenting in teenagers, ingrown toenails can occur at any age. People who have a family history of ingrown toenails, those who have thick or curved nails, and those who wear tight-fitting shoes or socks are more likely to develop this condition.

What Are Ingrown Toenails?

Ingrown toenails occur when the edge or corner of a toenail grows into the surrounding skin. This can cause pain, tenderness, swelling, and redness in the affected area. In some cases, the skin around the toenail can become inflamed, and an infection may develop.

A variety or factors can lead to the development of ingrown toenails. One of the most common causes is improper nail trimming. Cutting the nails too short or rounding the edges can cause the nails to grow into the skin. Other factors that can contribute to the development of ingrown toenails include wearing tight-fitting shoes or socks, thickened nails, fungal infections, sustaining an injury to the toe, or having genetically curved nails.

Different Types Of Ingrown Toenails

There are four main types of ingrown toenails.

  1. Pincer shape involution; the toenail grows completely curled in on both sides with a crab claw like appearance.
  2. Plicatured involution; the toenail curls in and under on one side shaped similar to a walking cane on its side.
  3. Tile shape involution; the toenail folds down on both sides at a right angle similar to a side view of a tile.
  4. Toenail spicule; usually due to inappropriate cutting technique, when a spike or ‘spicule’ is left in the corner of the toenail pushing into the adjacent soft tissue.
Ingrown Toenail Classification, Types of ingrown toenails, Podiatrist Sydney

Signs and Symptoms Of Ingrown Toenails

The signs and symptoms of an ingrown toenail can include pain, tenderness, swelling, and redness in the affected area. The skin around the toenail may also be inflamed, and there may be drainage or pus. In severe cases, an infection may develop, causing additional symptoms such as fever, increased swelling, and drainage that is thick and yellow.

What Else Could It Be? (Differential Diagnosis)

It is important to properly diagnose an ingrown toenail as there are other conditions that can present with similar symptoms. These conditions include:

  1. Infected toe: A bacterial or fungal infection can occur in the skin surrounding the toenail and cause redness, swelling, and pain that may mimic the symptoms of an ingrown toenail.

  2. Hypergranulation tissue of the toe: This is an overgrowth of skin tissue that can develop as a result of chronic irritation from shoes or socks that are too tight, and can present with similar symptoms to an ingrown toenail.

A podiatrist can conduct a thorough examination and review the individual’s medical history to properly diagnose an ingrown toenail and differentiate it from other conditions. This can help ensure that appropriate treatment is provided and that the condition is managed effectively.

What Causes Ingrown Toenails?

Improper nail cutting technique is the primary cause of most ingrown toenails, but abnormal nail shape can also contribute to this condition. When nails are cut too short or rounded, it can create a spike on the edge of the nail that punctures the adjacent skin, leading to an ingrown toenail. Wearing shoes that are too tight or have a narrow toe box can also put pressure on the toes and cause the nail to curve into the flesh, resulting in an ingrown toenail.

Furthermore, some individuals may have involuted toenails, which are naturally curved, increasing their risk of developing ingrown toenails. This condition can be due to a genetic predisposition or previous trauma. Additionally, biomechanical abnormalities such as poor foot alignment and gait or bony deformities may increase the pressure on the sides of the toes, causing the toenail to grow into the skin and resulting in an ingrown toenail.

Our team of experienced podiatrists can determine the root cause of a presenting ingrown toenail and provide appropriate treatment. They can also offer guidance on how to prevent ingrown toenails from recurring, such as proper nail trimming techniques and appropriate footwear choices.

Preventing Ingrown Toenails

There are several steps that individuals can take to prevent the occurrence of ingrown toenails:

  1. Proper Nail Care: Ensure that toenails are trimmed straight across rather than in a curved fashion. Do not trim the nails too short, and avoid cutting the edges of the nail too closely.

  2. Appropriate Footwear: Wear comfortable shoes that have a wide toe box to allow the toes to move freely. Avoid wearing shoes with high heels or pointed toes, which can cause the toes to become cramped and the nails to be pushed into the skin.

  3. Foot Hygiene: Maintain good foot hygiene by washing the feet regularly and keeping them dry. Moisture between the toes can lead to fungal infections, which can cause the nails to thicken and become more likely to become ingrown.

  4. Protect Your Feet: If you work in an environment where there is a risk of injury to the feet, wear protective footwear to prevent trauma to the toenails.

  5. Seek Treatment Early: If you notice any signs of an ingrown toenail, such as pain, swelling, redness, or drainage, seek prompt treatment from a podiatrist. Early treatment can prevent the condition from worsening and reduce the risk of complications.

By taking these steps, individuals can reduce the risk of developing ingrown toenails and promote overall foot health.

Treatment For Ingrown Toenails

Proper diagnosis is crucial for treating an ingrown toenail. An experienced podiatrist can accurately diagnose the condition and skillfully remove the ingrown portion of the nail, smooth out the nail edge, and address any infection that may be present. It is important to note that pain in the area surrounding the toenail can have various causes, including hypergranulating tissue, infection, foreign bodies, tumors, corns, and calluses, among others, which is why a proper diagnosis is essential.

Depending on the severity, causative factors, and duration of the ingrown toenail, various treatment options are available. Initial treatment for ingrown toenails should always be conducted by a podiatrist, particularly for individuals with diabetes mellitus or peripheral arterial disease.

In cases where ingrown toenails persist despite conservative treatments, permanent surgical interventions such as partial nail avulsion can be performed by a podiatrist. This procedure involves removing the invading portion of the nail all the way back to the nail matrix, where the nail grows from. The nail matrix is then treated with phenol to prevent any new nail growth and avoid the recurrence of the ingrown toenail. Skilled and experienced podiatrists can perform this procedure painlessly.

Additionally, an experienced podiatrist can address the underlying cause of ingrown toenails to prevent further complications such as recurrence, infection, and ulceration. They can provide guidance on proper nail trimming techniques and appropriate footwear choices, which can reduce the risk of developing ingrown toenails in the future.

When To See A Podiatrist

It is important to seek medical attention if there are signs of infection or severe pain. Signs of infection include increased redness, warmth, and drainage that is thick and yellow. If an ingrown toenail is causing severe pain or interfering with daily activities, it is important to seek the care of a podiatrist.

A podiatrist can provide treatment and advice on proper nail trimming techniques and footwear. They can also provide guidance on how to prevent the development of ingrown toenails.


To summarise, ingrown toenails are a common foot condition that can cause pain, discomfort, and swelling. There are different types of ingrown toenails that can affect individuals differently. Proper nail trimming techniques and wearing comfortable shoes can help prevent the development of ingrown toenails. If an ingrown toenail does develop, soaking the foot and seeking the care of a podiatrist may be necessary for treatment. It is important to seek prompt medical attention if there are signs of infection or severe pain.

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To prevent ingrown toenails from occurring toenails should be cut straight across and not cut too short. Picking or tearing at toenails should be avoided, as picking, or tearing at toenails can leave sharp pointed edges (spicules) that traumatise the surrounding flesh. Additionally, it is important to wear appropriate fitting footwear. The toe box of a shoe should not place excessive pressure on the toes. Narrow shoes can compress the toes, causing the toenail to grow into the skin, while loose shoes can lead to excessive movement in the shoe, also leading involuted or ingrown toenails. Regular toenail and foot skin maintenance from an experienced podiatrist is an effective way to prevent ingrown toenails, especially for those with diabetes mellitus, fungal infections, thickened toenails, or peripheral arterial disease, where changes to the toenail occur. Experienced podiatrists can help prevent ingrown toenails by recommending a variety of shoes suited for different foot types and lower limb biomechanics, as well as using specialised equipment to shape and guide the toenail to grow in an optimal manner. When conservative treatment proves to not be adequate, podiatrists can perform a toenail surgery know as a partial or full toenail avulsion where the invading section of a toenail is removed permanently.

It is a common misconception that you should cut a ‘V’ into your toenail to fix or prevent ingrown toenails. You should not cut a ‘V’ into the end of your toenail. The appropriate way to cut a toenail is straight across, avoiding going around the edges or down the sides. Podiatrists may round the edges when addressing ingrown toenails however, they have the medical training, experience, appropriate tools, and better angles to treat  ingrown toenails.

When left untreated, an ingrown toenail may become a portal of entry for infection, marked by inflammation, redness, pain, pus, and malodour. In extreme cases the infection may spread to the bloodstream or to the bone and for those with a reduced nerve sensation, an ulcer may form at the nail fold. For people who have peripheral arterial disease or diabetes mellitus, the risk of the ingrown toenail escalating to a soft tissue infection and possible ulceration is much greater and immediate attention should be sought from an experienced podiatrist.