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 the corner gets angry: Thickened nails from toenail fungus and toe crowding from bunions increase pressure on the nail fold.

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.

Prevent the next flare: Supportive shoes can reduce forefoot pressure that triggers arch and heel symptoms. See the guide to plantar fasciitis. Pain under the big toe joint may be sesamoiditis.

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.

Ingrown Toenail FAQ

Can I fix an ingrown nail at home?
Mild tenderness can settle with warm soaks, cotton lift, and careful trim. Infection, severe pain, or drainage needs professional care.¹

Do I need antibiotics?
Not always. If there is true infection with spreading redness or drainage, your clinician may pair antibiotics with a partial nail procedure.¹

Will it come back after the procedure?
The matrixectomy method has a high success rate when aftercare and shoe fit are addressed. Recurrence risk falls when both are optimized.¹

¹ References align with the main article’s citations from peer‑reviewed sources including JFAS, APMA, and AOFAS.

🦶 Recommended Products for Ingrown Toenails

These items are listed for education and reference only. They are not a substitute for medical advice. Please see your podiatrist for specific recommendations. I may receive a commission if you purchase through these links, at no additional cost to you.

🔧 Tools

• Barrel Hinged Nail Nipper – Sturdy clipper for thick or curved toenails

🧴 Skin & Nail Care

• Epsom Salts – Foot soaks to calm soreness and swelling around the nail
• Antifungal Shoe Spray – Keeps shoes clean to reduce infection risk

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.