An ingrown toenail develops when the edge of the nail grows into the skin beside it; it usually affects the big toe, and its commonest causes are poorly fitting shoes and toenails that are not trimmed properly [1][2][3]. In the early stage, measures such as soaking the foot in warm water and wearing wide shoes may be enough; when infection develops or home care does not help, the ingrown edge of the nail is removed under local anaesthetic [1][2][3]. According to a Cochrane review, surgical interventions are more effective than non-surgical methods in preventing recurrence [4].
What is an ingrown toenail and what causes it?
An ingrown toenail (onychocryptosis) is a common problem in which the edge of the nail grows into the fold of skin beside it, the flesh at the side of the nail, and creates a painful area [1][4]. Any toe can be affected, but it is usually the big toe [1][2]. It is seen most often in teenagers and young adults, although it can occur at any age [5].
The main causes are [2][3][6]:
- Cutting the nail too short or rounding off its corners
- Tight or short shoes that squeeze the toes
- Picking at the corners of the nail or tearing the nail
- An injury to the toe, or repeated stress such as running
- A nail that is naturally curved or too large for the toe
What are the symptoms and stages?
At first the skin at the edge of the nail may be hard, swollen and tender [2]. The toe becomes red, painful and swollen, and the nail may look as if it curves into the toe [1].
Most classifications divide the problem into three stages: mild, moderate and severe [5]. Redness, pain and swelling may soon be followed by infection; pus coming from the toe, or feeling hot, cold or shivery, suggests infection [1][2]. In most of the severest cases, chronic overgrown tissue (granulation tissue) forms at the edge of the nail and the skin fold thickens [6].
What helps at home, and which cream should be used?
In the early stage, before infection sets in, home care may prevent the need for further treatment [2]. If there is no improvement within 2 to 3 days, or if the condition gets worse, see a doctor [2].
People who have diabetes, nerve problems in the leg or foot, or poor blood circulation to the foot, and those with an infection around the nail, should see a doctor right away rather than spending time on home treatment [3].
As for creams, a pharmacist can advise on products that help to ease the pain and prevent infection [1]. If the toe is infected, a doctor may prescribe antibiotics [1][3]. However, according to a review written for doctors, antibiotics taken by mouth or applied to the skin before or after a procedure do not improve the outcome [6].
What you can do at home [1][2][3]:
- Soak the foot in warm water 3 to 4 times a day; salt can be added to the water
- Keep the foot dry for the rest of the day
- Wear wide, comfortable shoes or sandals; avoid tight, pointed shoes
- Gently lift the ingrown edge of the nail, place a small piece of cotton or waxed dental floss under it, and change it every day
- If you need a painkiller, ask a pharmacist or doctor which one is suitable
- Do not cut the nail, leave it to grow out; do not try to cut out the ingrown part yourself
Do nail braces and tube (gutter) methods work?
Non-surgical methods are generally used in the mild and moderate stages [5][6]. With a nail brace (orthonyxia), a small metal brace is fitted onto the nail [4][6]. In the tube (gutter) method, a thin plastic tube slit lengthwise is slipped over the ingrown edge of the nail after the toe has been numbed; patients frequently report pain relief [6].
The success rates of these methods and the quality of the evidence vary [5]. According to the Cochrane review, surgical interventions are better at preventing recurrence than the gutter method and probably better than nail braces [4]. A systematic review published in 2023, however, found no significant difference in recurrence between surgical and non-surgical methods, and rated the certainty of this evidence as low or very low [5].
When is a procedure needed, and which doctor treats it?
If home care is not helping, you need to see a doctor [1][3]. If there is marked inflammation, swelling, pain and discharge, the nail is probably infected; antibiotics, and removal of part or all of the nail, may be needed [2].
Surgical methods are preferred in the moderate and severe stages; surgery is also often recommended when non-surgical treatment has not worked [5][6]. An untreated ingrown toenail causes substantial pain and inflammation and increases the risk of infection [5].
Nail surgery is performed by a range of health professionals, such as family doctors, orthopaedic surgeons, dermatologists and podiatrists (foot health specialists) [5]. At this clinic, ingrown toenails are assessed and treated by the orthopaedics and traumatology doctors.
How is ingrown toenail surgery done?
The procedure is done under local anaesthetic; the numbing injection is given at the base of the toe [2][3][7]. The most common method is to remove only the ingrown side edge of the nail [3][6]; in some cases the whole nail is removed [1][2][7]. According to the patient leaflet of an NHS hospital in England, the operation usually takes about 10 to 15 minutes, after which you go home [7].
When only the ingrown edge is removed, it takes 2 to 4 months for the nail to regrow [3]. To stop the same edge from growing back and digging in again, the nail root (matrix) can also be treated; this can be done surgically, with a chemical (for example phenol) or with an electric current [6][7].
According to the Cochrane review, adding phenol to the procedure is probably more effective in preventing recurrence; however, because there is only one study in which the same surgery was used in both groups, this result needs to be confirmed [4]. In that study, recurrence was 14% in the group that received phenol and 41% in the group that did not [4]. The 2023 review also concluded that phenol reduces the risk of recurrence, but it rated this evidence as very low quality [5].
After the procedure: healing, bathing and going back to work
When the nail root is treated, pain is generally minor [6]. The dressing is changed within 24 to 48 hours and normal walking can be resumed; a discharge from the nail bed is to be expected for 2 to 3 weeks [6]. A toe treated with phenol takes approximately 6 to 8 weeks to heal, and may take as long as 12 weeks [7]. Rarely, permanent loss of the nail or a misshapen nail may occur [6].
Care instructions are given by the doctor who carries out the procedure. The patient leaflet of an NHS hospital advises the following [7]:
- Keep the foot raised as much as possible for the first 24 hours
- You can have a bath or shower as normal with the dressing left on the toe; the dressing is renewed afterwards
- You can go back to work or school the next day if you can keep the foot raised
- Do not take part in sport until the toe has healed
Does it come back, and how can it be prevented?
An ingrown toenail is likely to return if good foot care is not practised [3]. After a procedure with phenol, the nail grows back in fewer than 10 out of 100 people [7]; the review written for doctors reports a recurrence rate of less than 5% after phenol [6].
The following are recommended for prevention [1][2][3]:
- Cut the nails straight across; do not round off the corners
- Do not cut the nails shorter than the tip of the toe
- Use clean, sharp nail clippers
- Wear shoes and socks that leave enough room for the toes
- Keep the feet clean and dry them thoroughly
- If you have diabetes, have regular foot examinations and nail care
When not to wait
In the following situations see a doctor without waiting [1][2][3][7]:
- The toe is painful and swollen and pus is coming out of it
- You have a high temperature, or feel cold or shivery
- You have diabetes, nerve damage in the leg or foot, or poor circulation to the foot
- There is no improvement within 2 to 3 days, or the condition is getting worse
- Heat, swelling and pain have developed in the toe after a procedure
Frequently asked questions
- Which department or doctor treats an ingrown toenail?
- Nail surgery is performed by a range of health professionals such as family doctors, orthopaedic surgeons, dermatologists and podiatrists [5]. At this clinic, ingrown toenails are treated by the orthopaedics and traumatology doctors.
- How long does ingrown toenail surgery take, and is it painful?
- The procedure is done under local anaesthetic and usually takes about 10 to 15 minutes [7]. There may be some pain once the numbness wears off, and painkillers help [7]; when the nail root is treated, pain is generally minor [6].
- How many days does it take to heal after surgery, and when can I bathe?
- You can go back to work or school the next day if you can keep the foot raised; a toe treated with phenol, however, takes approximately 6 to 8 weeks to heal and may take as long as 12 weeks [7]. You can have a bath or shower as normal with the dressing left on the toe; the dressing is renewed afterwards [7].
- Which cream is good for an ingrown toenail?
- A pharmacist can advise on products that help to ease the pain and prevent infection [1]. Antibiotic creams and antibiotics taken by mouth, used before or after a procedure, have been reported not to improve the outcome [4][6].
- Can an ingrown toenail settle without surgery, and what happens if it is not treated?
- In the early stage, before infection sets in, home care may prevent the need for further treatment [2]. If it is left untreated, however, there is substantial pain and inflammation, and the risk of infection increases [5].
This article is a general summary; diagnosis and treatment decisions are made by the doctor who examines you.
Sources
- Ingrown toenail. NHS (nhs.uk), 2025. nhs.uk
- Ingrown Toenail. American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
- Ingrown toenail. MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine), 2025. medlineplus.gov
- Interventions for ingrowing toenails. Cochrane Database of Systematic Reviews (Eekhof JA, et al.), 2012. pubmed.ncbi.nlm.nih.gov
- A systematic review and meta-analysis of randomised controlled trials on surgical treatments for ingrown toenails part I: recurrence and relief of symptoms. Journal of Foot and Ankle Research (Exley V, et al.), 2023. pubmed.ncbi.nlm.nih.gov
- Ingrown Toenail Management. American Family Physician (Mayeaux EJ, et al.), 2019. pubmed.ncbi.nlm.nih.gov
- Nail Surgery (patient information leaflet PIL1199). North Tees and Hartlepool NHS Foundation Trust, n.d.. nth.nhs.uk
This article is general information and does not replace an examination or imaging. If you have symptoms, see a doctor.
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