Ingrown Toenail
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
An ingrown toenail is when the side of a nail curls down and grows into the skin beside it. It is common: about 20 per cent of foot problems seen in primary care are ingrown toenails. Teenagers are most often affected, and it usually involves the big toe. The main symptom is pain, often with redness and swelling, and it can become infected. Mild cases may ease with simple care, but it generally needs proper treatment to be cured. Nail surgery works well when the problem keeps coming back.
What is it?
An ingrown toenail (onychocryptosis) happens when the side of your nail curls down and pierces or grows into the skin beside it. This causes pain and inflammation (the skin becomes tender, red and swollen). If it isn't treated, it can become infected.
It most often affects the big toe, but any toe can be involved. A nail that curls into the skin without actually piercing it is not a true ingrown toenail. It can still be very sore, red and inflamed, so it is worth keeping an eye on.
Ingrown toenails are common. About 20 per cent of foot problems seen in primary care, and about 20 per cent of people who go to a clinic with a foot problem, turn out to be ingrown toenails. Those figures come from people visiting clinics, so they don't tell us how many people in the general population get one.
Who does it affect?
An ingrown toenail can happen at any age, but teenagers are the most likely to get one. Males are affected more often than females. In 80 per cent of cases only one foot is affected, and the big toe is the usual toe.
People with diabetes need to take extra care. An ingrown toenail can raise the risk of a foot ulcer (an open sore) in people with diabetes. The same goes for people with poor circulation, nerve damage in the feet or legs, or a weakened immune system, because infection is more likely.
Signs and symptoms
Pain is the main symptom. It often starts as minor discomfort at the edge of the nail and builds over time. The toe may be tender, red and swollen, with hardened skin around the nail. Pressing on the nail can hurt, and the nail may curve into the toe.
The symptoms usually get worse rather than better. If the toe becomes infected, you may notice pus or fluid coming from beside the nail, throbbing pain, bleeding, and warm, red skin around the nail. Left alone, it can make walking difficult.
What causes it?
The most common cause is cutting your nails the wrong way. Cutting them too short, rounding them down into the corners, or picking and tearing at the edges can all lead to an ingrown toenail. The safer way is to cut straight across.
Footwear is the other big cause. Tight, narrow or pointed shoes, tight socks, and tights that crowd your toes press the nail into the skin.
Other things can add to the problem:
- Nails that arch or curve upwards in the middle, or that are naturally curved or fan-shaped
- An injury to the toe, such as stubbing it
- Sweaty feet
- Fungal nail infection
- Foot shapes such as bunions or hammer toes
- Repeated knocks to the toes from sports such as football, ballet or running
- A side effect of a medicine called isotretinoin
How is it diagnosed?
Your podiatrist or GP can usually tell what it is by looking at your toe and asking about your symptoms. They may ask how long it has been sore, whether you have hurt the toe, how you cut your nails and what shoes you wear. They will also check for signs of infection.
Occasionally, other problems can look like an ingrown toenail. These include a bony growth under the nail, an infection in the toe bone, a growth in the nail bed, and a nail problem called retronychia. If something looks different from a typical ingrown toenail, your practitioner will want to look into it further rather than treat it as routine.
Ingrown toenails are sometimes described as mild (stage I), moderate (stage II) or severe (stage III). The stage helps your practitioner choose your treatment.
Treatment
The right treatment depends on how advanced the problem is. Simple care is usually tried first for mild to moderate cases. Surgery is used for later stages, or when the problem keeps coming back or doesn't respond. A first ingrown toenail is likely to settle, but slowly.
Looking after it at home
If the nail is cutting in, soak your foot in warm water for 15 to 20 minutes, 3 or 4 times a day. Afterwards, use a cotton bud to gently push the skin away from the corner of the nail. Wear wide, comfortable shoes, and cut your nails straight across and not too short.
Don't pick at the nail, and don't try to remove it yourself. Home care is also not suitable if you have diabetes, poor circulation or nerve damage in your feet or legs. In that case, see your podiatrist or doctor first.
Treatment from your podiatrist
Your podiatrist may use a gutter splint or a brace (devices that help the nail grow out without digging in). These are the usual first step in the early stages and are mostly effective then. It isn't clear yet how well they work compared with surgery.
Your podiatrist can also help with nail cutting and footwear advice.
Surgery
Your podiatrist or doctor may suggest nail surgery, done under local anaesthetic (numbing medicine), if your ingrown toenail keeps coming back, isn't improving, or needs several courses of antibiotics. Surgery is better at preventing it coming back than gutter splints, and probably better than braces.
The most commonly used approach removes the edge of the nail and treats the nail root with a chemical (phenol) so that part of the nail doesn't grow back. No single technique is perfect. Another approach removes some of the skin fold beside the nail, but how well it works isn't clear yet.
After surgery, watch for signs of infection. A significant increase in redness, swelling or pain, discharge, a bad smell, or flu-like symptoms need prompt attention (see the warning signs below).
Recovery
An ingrown toenail generally doesn't go away by itself and needs proper treatment to be cured. A first episode is likely to settle, but slowly.
If it keeps returning, see your podiatrist early rather than waiting. Surgery is the option that best prevents it coming back. Looking after your nails and shoes helps too.
Preventing it
A few simple habits make a big difference:
- Cut your toenails straight across, and not too short.
- Don't pick or tear the corners of your nails.
- Wear shoes with room for your toes, and avoid narrow, pointed shoes.
- Avoid tight socks and tights that crowd your toes.
- Keep your feet clean and thoroughly dry.
- If your nails arch upwards in the middle, ask your podiatrist to help you cut them. This kind of nail is more common as you get older.
When to see a podiatrist
Book an appointment if
Home care isn't helping, the toe keeps hurting, or you have had an ingrown toenail before and it keeps coming back. Also book if you have needed more than one course of antibiotics for it, or if your nails arch upwards and you find them hard to cut.
Seek prompt assessment if
Your toe is swollen with visible pus, feels warm, is getting more painful, or the redness is spreading into your foot or leg, or you have a fever and feel unwell: see your GP or another doctor today. If your GP can't see you today, go to an urgent care clinic or an after-hours GP. If you have an infected toe and you also feel very unwell, with confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine, this could be sepsis: call your local emergency number.
You have diabetes, poor circulation, nerve damage or a weakened immune system, and your toe is getting worse or has new redness, heat or swelling: take weight off the foot and contact your foot team or GP today, because foot problems can worsen within hours. If they can't see you, use an after-hours GP, an urgent care clinic, or a health advice phone line if there is one where you live.
You have had nail surgery and notice a significant increase in redness, swelling or pain, discharge, a bad smell or flu-like symptoms: contact your podiatrist or GP promptly, as you may need antibiotics.
Something on or under the nail doesn't look like a usual ingrown toenail, or it isn't settling: see your podiatrist or GP soon.
Frequently asked questions
Do I need antibiotics for an ingrown toenail?
Not always. If the toe becomes infected, your GP or podiatrist will decide whether you need them. Needing several courses is a reason to talk about nail surgery. After surgery, antibiotic tablets don't appear to lower the chance of infection.
Who treats an ingrown toenail?
Your podiatrist or GP can assess it and start treatment. If you need nail surgery, it is done by a podiatrist or doctor trained in nail surgery.
What should I tell my podiatrist before nail surgery?
Tell them if you have had any anaesthetic in the last 24 hours, and if you have epilepsy. Keep taking your regular tablets unless you are told to stop.