Ingrown Toenails: Causes, Myths, and How They’re Treated Gotham Footcare

Ingrown toenails may seem like a minor nuisance at first, but anyone who has experienced one knows just how painful and disruptive they can be. From the sharp sting with every step to the visible swelling and redness, ingrown toenails have a way of making even the simplest tasks uncomfortable. While common, this condition is frequently misunderstood. Many people wait too long to seek treatment, try ineffective home remedies, or even worsen the issue through misguided advice.

What Is an Ingrown Toenail?

An ingrown toenail occurs when the edge of a toenail grows into the surrounding skin, rather than over it. This abnormal growth triggers inflammation, swelling, and often infection. The most commonly affected toe is the big toe, although any toenail can become ingrown. Early stages may present as mild redness or tenderness along the nail edge, but if left untreated, the pain can intensify, and the area can become infected, producing pus, increased warmth, and sometimes even difficulty walking.

This condition affects people of all ages and activity levels. However, athletes, teenagers, people with diabetes, and individuals with a family history of ingrown nails may be more prone to developing them. Understanding the underlying causes is key to both prevention and treatment.

Common Causes of Ingrown Toenails

The development of an ingrown toenail usually stems from a combination of anatomical, environmental, and behavioral factors. One of the most common culprits is improper nail trimming. Cutting the nails too short or rounding the corners can encourage the nail to grow into the skin. This is especially problematic if the nail is trimmed beneath the skin line, which removes the natural barrier that directs nail growth outward.

Footwear also plays a significant role. Shoes that are too tight or narrow in the toe box can compress the toes and push the nail into the skin. High heels, pointed-toe dress shoes, and poorly-fitted athletic shoes can all contribute to this condition. Repetitive pressure and friction from these types of footwear increase the risk of nail trauma, leading to abnormal nail growth patterns.

Another contributing factor is trauma to the toenail. Stubbing the toe, dropping something on the foot, or repetitive pressure from sports like soccer or running can damage the nail and its surrounding tissue. This damage may cause the nail to grow irregularly or the skin around the nail to swell, increasing the chance of it becoming embedded.

In some individuals, anatomy plays a natural role. People born with unusually curved or thick nails, or with excessive soft tissue around the nail bed, are more likely to develop ingrown nails, even with proper care. These individuals may experience recurring episodes despite good foot hygiene.

The Role of Infection and Complications

Once the nail breaks through the skin, it opens the door to infection. Bacteria such as Staphylococcus aureus or Pseudomonas can quickly colonize the area. This leads to increased redness, swelling, warmth, and the formation of pus. The infected area can become very painful and may even release a foul odor.

In healthy individuals, this infection can typically be managed with local care or antibiotics. However, in people with compromised immune systems—such as those with diabetes, poor circulation, or neuropathy—an ingrown toenail can escalate into a serious health concern. In severe cases, untreated infections can spread to the underlying bone, leading to osteomyelitis. This is a medical emergency that requires prompt treatment and, in some cases, surgical intervention.

It is essential not to ignore signs of infection or rely solely on home remedies if the area becomes red, hot, swollen, or if pus is present. Timely professional care can prevent minor infections from developing into more serious complications.

Myths and Misconceptions About Ingrown Toenails

Many myths circulate around the topic of ingrown toenails, some of which can delay proper treatment or make the problem worse. One common misconception is that cutting a “V” shape in the center of the nail will relieve pressure and prevent the nail from growing inward. In reality, there is no anatomical reason why this would work, and it can lead to further improper growth patterns.

Another popular myth is that soaking the foot in Epsom salts or applying topical ointments will permanently resolve an ingrown nail. While warm soaks can temporarily relieve discomfort and reduce swelling, they do not correct the underlying issue, especially if the nail is deeply embedded or infected.

Many believe that simply wearing sandals or avoiding tight shoes will fix the problem. While reducing pressure can alleviate symptoms, it does not remove the offending nail edge that has already grown into the skin. The condition may temporarily improve, but without proper nail care, the symptoms usually return.

Some people are reluctant to seek professional help due to fear of pain or surgery. However, modern treatments for ingrown toenails are typically quick, effective, and minimally invasive. Avoiding medical care out of fear often leads to worsened infections and more extensive procedures later.

Diagnosing an Ingrown Toenail

Diagnosis of an ingrown toenail is usually straightforward and based on clinical examination. A healthcare provider will assess the toe for signs of inflammation, infection, and nail penetration. They will evaluate whether the condition is in an early stage—mild redness and tenderness—or more advanced, involving pus, swelling, and significant pain.

If the problem is recurrent or if there is suspicion of a deeper infection, imaging studies such as an X-ray may be used to assess the condition of the underlying bone and detect any signs of osteomyelitis. This is more common in patients with diabetes or those who have delayed seeking treatment.

The provider will also review the patient’s nail-cutting habits, footwear, medical history, and any past trauma to help identify contributing factors. Understanding the full context is essential for creating an effective treatment plan and preventing recurrence.

Non-Surgical Treatments

In the early stages, ingrown toenails can often be managed without surgery. The goal of conservative treatment is to reduce inflammation, prevent infection, and guide the nail to grow in the correct direction. Warm water soaks with Epsom salts can help reduce mild swelling and soften the nail and skin, making it easier to manage.

Topical or oral antibiotics may be prescribed if infection is present. These help control bacterial growth and allow the inflamed tissue to heal. In cases where the nail is only slightly embedded, a healthcare provider may gently lift the nail edge and place a small piece of cotton or dental floss underneath to separate it from the skin. This technique, called “nail splinting,” helps train the nail to grow properly.

Patients are advised to wear open-toed or wide shoes to minimize pressure, and to avoid cutting the nail too short or tapering the edges. With consistent care, many mild cases will resolve without the need for surgical intervention.

Surgical Treatment Options

For moderate to severe cases, or for those that do not respond to conservative care, minor surgical procedures are often necessary. One common method is partial nail avulsion, where the ingrown edge of the nail is removed under local anesthesia. This is a quick, in-office procedure that provides immediate relief.

In cases where the ingrown toenail is recurrent, the physician may recommend destroying the nail matrix—the tissue that generates nail growth—on the affected side. This is often done using a chemical called phenol or through cauterization. The goal is to prevent the offending portion of the nail from growing back. This procedure is called a “partial matrixectomy.”

For patients with severe nail deformities or chronic infections, total nail removal may be considered. However, this is less common and usually reserved for extreme cases. Most patients recover quickly after partial procedures, with minimal downtime. Postoperative care includes keeping the area clean, avoiding tight shoes, and using antibiotic ointment or dressings as instructed.

Preventing Ingrown Toenails

Prevention begins with proper nail trimming. Toenails should be cut straight across, not rounded or angled at the edges. This encourages the nail to grow straight and reduces the likelihood of it digging into the surrounding skin. Nails should also not be cut too short—leave a small amount of nail visible above the skin line.

Wearing properly fitting shoes is essential. Choose footwear with a wide toe box that does not compress the toes. Avoid wearing high heels or pointed shoes for extended periods. For athletes, it’s important to select sport-specific shoes that provide adequate protection and allow for toe movement.

Foot hygiene plays a key role. Keep the feet clean and dry, and inspect the toes regularly for signs of irritation or pressure. Those with diabetes, poor circulation, or nerve problems should have their feet examined regularly by a podiatrist to catch issues early and avoid complications.

If you are prone to ingrown toenails due to genetic factors or past injuries, regular professional nail care may help. Seeing a podiatrist every few months for trimming and guidance can significantly reduce the likelihood of recurrence.

Special Considerations for People with Diabetes

Ingrown toenails pose a particular risk for people with diabetes. Due to impaired circulation and reduced sensation (peripheral neuropathy), minor injuries can go unnoticed and escalate quickly. An ingrown toenail in a diabetic patient may become infected more easily and heal more slowly, increasing the risk of severe complications, including foot ulcers and amputations.

For this reason, diabetic individuals should never attempt to self-treat an ingrown toenail. Any signs of redness, swelling, pain, or drainage should prompt immediate evaluation by a healthcare professional. Routine foot exams, including regular visits to a podiatrist, are vital in managing foot health and preventing severe outcomes.

When to See a Specialist

While some ingrown toenails can be managed at home, others require professional care. If the pain is severe, if the toe becomes increasingly red or swollen, or if there is pus or bleeding, it’s time to seek medical attention. Similarly, if the ingrown toenail keeps returning, surgical treatment may be the best option.

Individuals with diabetes, immune suppression, or poor wound healing should not attempt home remedies. A podiatrist can offer expert guidance and treatment to resolve the problem safely and effectively. In many cases, early intervention leads to faster healing and fewer complications.

Conclusion

Ingrown toenails may seem like a minor issue, but when left untreated, they can become a source of significant pain and even serious infection. Understanding the causes—from improper trimming and tight shoes to genetic predisposition and trauma—can help you take proactive steps toward prevention. Dispelling common myths and knowing when to seek medical care are equally important.

Treatment options range from conservative approaches like warm soaks and antibiotics to minor surgical procedures that offer permanent relief. With proper care and attention, most cases can be managed quickly and effectively. If you find yourself dealing with recurring or worsening symptoms, don’t ignore the problem. Your feet deserve attention, comfort, and professional care when needed. Contact our Gotham Footcare team at (212) 921-7900.