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Ingrown Toenail

Ingrown toenails can be very painful and frustrating. They can stop you from being able to wear shoes, partake in activities you enjoy and cause discomfort with every step you take.


What is an ingrown toenail?

The term ingrown toenail refers to one or both edges of your nail growing down to pierce the surrounding skin. In most cases, the nail edges will curve down into the skin, however, the presence of extra or swollen skin surrounding the nails may obstruct regular nail growth and result in the nail piercing the skin. Initially, the nail may push tightly against the skin which can cause tenderness, but it is the moment the nail cuts through the skin that it is deemed ‘ingrown’ and the risk of complications such as infection begin. Ingrown toenails often affect the big toe, though can occur at any of the toes.


What causes ingrown toenails?

Various factors can encourage ingrown toenails, the most important common of which is an improper nail cutting technique. Nails should be cut in a straight, clean line with no fraying or split edges and no curves. Curving or ‘rounding’ the edges of the nail down the side can encourage the nail to grow curved down into the skin.


Another common culprit is pulling or picking the nails. Pulling the top of the nail off, instead of cutting them in a straight line with a tool, can leave a spicule at the edge of the nail where it is ripped off, often deep down the side of the nail where it is not visible or felt – until it starts growing and pierces the skin.


Tight footwear creates pressure on the sides of the toes that can push the nail into the surrounding skin. The shape of the nail can also play a role, especially where the nail is particularly involuted or curved. This is often linked to uncontrollable genetic factors that dictate the features and shape of the nail.


What are the symptoms?

Ingrown toenails are usually easy to spot because of the marked swelling at the sides of the nail. Common symptoms include:

  • Redness
  • Tenderness
  • Swelling/inflammation
  • Mild to severe pain on touch
  • Occasional bleeding at the pierced site
  • Yellow/clear discharge if an infection is present

In severe cases, it will become difficult to wear shoes or have anything touching the toe, even something as light as a sheet in bed.


How is an ingrown toenail treated?

Ingrown toenails can be managed as a one-off, or can be corrected permanently. For conservative one-off treatment, your Podiatrist will remove the offending nail edge or spicule. Removing the nail spicule means the pierced skin is able to heal and the inflammation, and hence pain, will be able to settle. This may be the best option if the ingrown nail is occurring for the first time. However, if this has occurred multiple times, then you may wish to permanently correct the nail edge.


The procedure for permanent correction is called a Partial Nail Avulsion (PNA)with a chemical metrixectomy. It involves removing a small section of the nail and applying a chemical to destroy the nail growing cells down the offending edge. The result is a clean, straight nail edge that is only a few millimetres shorter than your standard nail, and barely noticeable.

To learn more about the ingrown toenail surgery and all of the options, click here.

The risk of infection

As with any opening in the skin, ingrown toenails carry with them the risk of infection, which is amplified by the location of the wound down at the feet. This makes seeking appropriate treatment for ingrown toenails very important, especially if you have diabetes, nerve damage or poor circulation, all of which increase your risk for adverse effects. Individuals with these conditions should not attempt to treat their ingrown toenails at home and should seek the help of their Podiatrist as soon as possible.