What Causes Ingrown Toenails?
An ingrown toenail develops when the edge or corner of the nail grows into the soft skin alongside it. This creates pressure, irritation, and eventually a break in the skin that can become infected. The big toe is most commonly affected, though any toenail can become ingrown.
Several factors contribute to ingrown toenails:
Nail cutting technique. Cutting nails too short or rounding the corners encourages the nail edge to grow into the skin as the nail regrows. The correct technique is to cut straight across, leaving the corners slightly visible above the skin edge.
Tight footwear. Shoes that compress the toes push the skin against the nail edges. Pointed-toe shoes, shoes that are too narrow, and ill-fitting boots are common culprits.
Genetic nail shape. Some people inherit nails that are naturally curved (involuted) or thickened, making them more prone to growing into the surrounding skin.
Trauma. A stubbed toe, dropped object, or repetitive pressure from sport (runners and footballers are particularly affected) can damage the nail or nail bed, leading to abnormal regrowth.
Sweaty feet. Excessive moisture softens the skin around the nail, making it easier for the nail edge to penetrate.
Previous nail damage. A toenail that has been lost or damaged may regrow with an altered shape that makes it more likely to become ingrown.
Symptoms and Stages
Ingrown toenails tend to progress through recognisable stages if left untreated:
Stage 1 — mild. Tenderness along the nail edge, particularly when pressed or when wearing shoes. The skin alongside the nail may appear slightly red or swollen.
Stage 2 — moderate. Increased pain, redness, and swelling. The skin may feel warm to the touch. There may be clear fluid weeping from the area. Walking and wearing enclosed shoes becomes noticeably uncomfortable.
Stage 3 — infected. The area becomes significantly swollen, red, and painful. Pus may be visible. The pain may become throbbing and constant. Hypergranulation tissue (proud flesh) may develop — a red, fleshy lump alongside the nail that bleeds easily.
Progression is not inevitable — some ingrown toenails remain mild and resolve with conservative care. However, once infection has developed, professional treatment is strongly recommended.
Temporary Pain Relief
While waiting for a professional appointment, the following measures can help manage discomfort:
Salt water soaks. Soak the affected foot in warm salt water for 10–15 minutes, two to three times daily. This helps reduce inflammation and keeps the area clean.
Paracetamol and ibuprofen. Over-the-counter pain relief can take the edge off.
Loose footwear. Switch to the widest, most open shoes you own. Sandals or open-toed shoes are ideal.
Elevation. When resting, prop your foot up above heart level to ease throbbing pain.
Do not attempt bathroom surgery. Digging down the side of the nail with scissors or other tools is one of the most common mistakes — and one of the most counterproductive. It risks introducing infection and making the problem significantly worse.
These measures are temporary — they manage symptoms while you arrange professional treatment, but they do not address the underlying cause.
When Pain Means Infection
An infected ingrown toenail requires professional attention. Signs that infection has developed include:
Pain that is increasing rather than staying the same. A noticeable change from tenderness to throbbing is significant. Redness spreading beyond the immediate area of the nail edge. Swelling that makes the toe look noticeably larger. Pus — a yellow, green, or white discharge. Warmth — the affected area feels warmer than surrounding skin. In more advanced cases, red streaks extending from the toe, fever, or feeling generally unwell.
If you are experiencing these symptoms, do not delay seeking treatment. Patients with diabetes, poor circulation, or compromised immune systems should treat any signs of infection as urgent.
The Permanent Solution
For recurring or infected ingrown toenails, surgery offers a permanent resolution. Phenol matrixectomy — the procedure performed at our Hendon clinic — removes the offending nail edge and prevents it from regrowing.
The procedure takes approximately 45 minutes under local anaesthetic. You walk in, have the procedure, and walk out the same day. Most patients return to normal activities within a few days, and the toe is fully healed within 6–8 weeks.
The cost at our clinic is £286 per toe, all-inclusive. Emergency appointments are available within 24 hours for £500.
Prevention Tips
While not all ingrown toenails can be prevented, the following habits reduce your risk:
Cut nails straight across. Do not round the corners. Leave the nail just long enough that you can see the corner above the skin edge.
Wear shoes that fit. Choose shoes with a wide toe box, and avoid narrow or pointed shoes for extended periods.
Keep feet clean and dry. Change socks daily, choose breathable materials, and allow shoes to air out between wears.
Protect your toes. Wear appropriate footwear for activities that put your feet at risk.
Do not pick or tear nails. Always use clippers for a clean, straight cut.