Ingrown Toenails: Causes, Home Remedies, and When to See a Podiatrist

TLDR

Ingrown toenails hurt, they can become infected, and they almost never “just go away.” Mild cases can sometimes be calmed at home with trimming, soaking, and better shoes, but once redness, swelling, or pus appear it’s time to call your podiatrist. In-office treatments range from a simple trim to a permanent fix.

What Is an Ingrown Toenail?

An ingrown toenail (onychocryptosis) develops when the edge of the nail grows into the surrounding skin instead of straight out. This causes pain, redness, swelling, and in many cases infection. It is one of the most common nail problems we see in podiatry, accounting for up to 20% of all foot care visits¹.

For many patients, an ingrown toenail is the first time they truly “notice” their toenails. One week you’re ignoring them, the next you can’t even put on socks without wincing.

Why Do Toenails Become Ingrown?

There is rarely a single reason. In most cases it’s a combination of factors:

1. Trauma

Toenails are built to protect the top of the toe from direct pressure—like someone stepping on your foot. They are not built to handle sideways blows, like stubbing your toe on furniture at 3 AM. This side impact pushes the soft nail fold into the nail plate, creating a wound that the nail edge continues to aggravate.

2. Shoe Gear

Shoes that are too short, too narrow, or too pointed press the skin of the toe directly into the nail. Over time this repeated pressure leads to nail border irritation and eventual ingrowth.

3. Genetics (Born to Ingrow)

Some nails are simply too wide or too curved for the toe they sit on. Children often present during growth spurts, while older adults may develop “pincer nails” (curved like a horseshoe) with age.² Unfortunately, in these cases trimming and shoe changes can only do so much.

4 month old with an ingrown toenail. We temporarily removed the offending border in hopes that as it grows back it will get more in sync with the growing toe

4. Nail Cutting Technique

The myth is that cutting straight across will prevent ingrowns while curving the nail invites them. In truth, both methods are fine if you’re consistent. The problem comes when corners are cut too deeply. That allows the soft skin fold to collapse inward, forcing the nail to pierce through again as it grows.

5. Fungal or Thick Nails

Fungal infections often make nails thick, brittle, and distorted. This extra bulk puts pressure on the surrounding skin and raises the risk of ingrowth.³

Who Gets Ingrown Toenails?

• Children: Ingrown nails often appear during growth spurts (ages 9–12 and 16–20).² Babies can even present with them—sometimes the nail is simply larger than the tiny toe can accommodate.

• Adults: Trauma, shoe gear, and fungal infections dominate here.

• Older adults: Decades of repetitive stress can cause exaggerated nail curvature. Poor circulation also raises the stakes if infection develops.

Home Treatments: What Works and What Doesn’t

Here’s a breakdown of common home remedies:

Home Treatment	Does It Help?	Why
Proper trimming	✅	Consistent straight or curved cutting, not too short
Wider shoes	✅	Prevents pressure on the nail folds
Soaking in warm water/Epsom salts	✅	Reduces inflammation and debris
Cutting a V in the nail	❌	The nail grows from the root, not the tip
Cotton under the nail	❌	Damages the nail plate and worsens the problem
Bathroom surgery	❌	High risk of infection and incomplete removal

Key takeaway: prevention beats bathroom surgery. Trim consistently, wear shoes with room in the toe box, and manage thick or curved nails early.

When To See a Podiatrist

Call your podiatrist if:

• Pain is worsening despite home care

• The nail border is red, swollen, or draining pus

• You have diabetes, vascular disease, or poor healing ability

• The ingrown keeps recurring

Left untreated, infection can spread deeper into the toe and even to bone in high-risk patients⁴.

In-Office Treatments

Slant Back (No Anesthetic)

A partial trim of the nail edge at an angle. Useful for mild, non-infected ingrowns.

Temporary Nail Removal (Nail Avulsion)

The toe is numbed with local anesthetic, the ingrown portion is separated and removed, and the area is dressed. The nail usually regrows within 9–12 months.

Permanent Nail Removal (Matrixectomy)

For chronic or recurrent cases. After removing the ingrown edge, a chemical (commonly phenol) is applied to the nail root to stop regrowth. Studies show 85–95% success rates with this method⁵. Healing takes a few weeks, but once healed recurrence is rare.

Key Takeaways

• Ingrown toenails are common, painful, and often unavoidable. Sometimes you just get unlucky.

• Home remedies can help in very mild cases, but infected or recurring nails need professional care.

• Podiatric procedures are simple and effective, and often less painful than the ingrown itself.

• Permanent removal offers lasting relief for recurrent problems.

Products Actually Used or Recommended In My Practice for Ingrown nails:

These items are listed for education purposes and references only, not to replace seeing your provider for specific recommendations, I may receive commission for any items purchased.

Urea Nail Gel- For making the nail softer and easer to trim and manage. May help keep the nail from getting too thick or brittle and impaling in to the skin

Podiatry Nail Nippers- The only way to get the correct angle to keep the nail beveled is to use the right tool. Trying to make that turn with flat nail clippers is nearly impossible. IF you’re going to do bathroom surgery, I can’t talk all of you out of it, at least use the best tool for the job. Good for people with chronically incurvated nails as well to keep the nail beveled and pain free.

Epsom Salts- Use when the nail is looking or feeling angry, you start seeing swelling or redness, and especially use them after a nail procedure is performed.

References

1. Heidelbaugh JJ, Lee H. Management of the Ingrown Toenail. Am Fam Physician. 2009;79(4):303-308.

2. Heidelbaugh JJ, Lee H. Clinical Review: Ingrown Toenail. BMJ. 2019;366:l4182.

3. Gupta AK, Versteeg SG. Onychomycosis and Fungal Nail Infections. Dermatol Clin. 2015;33(3):389–395.

4. Zuber TJ. Ingrown Toenail Removal. Am Fam Physician. 2002;65(12):2547-2552.

5. Heidelbaugh JJ, Lee H. Complications and Recurrence after Phenol Matrixectomy. J Foot Ankle Surg. 2013;52(1):48-52.