Introduction

Ingrown toenails are a common problem, especially on the big toes. They arise if the toenail grows into the skin next to it. That area becomes inflamed or infected and painful.

The medical term for ingrown toenails is onychocryptosis or unguis incarnates.

They are more likely to occur if you wear tight shoes, have very sweaty feet, or cut your toenails the wrong way.

At a glance

• Ingrown toenails are more likely to occur if you wear tight shoes, have very sweaty feet, or cut your toenails the wrong way.
• They can cause nearby tissue to become inflamed or infected and painful.
• Getting treatment in time can help to stop the infection from spreading.
• It is also important to avoid putting pressure on the nail.

Symptoms

Ingrown toenails cause the affected skin to become inflamed or infected. The blood supply to that part of the toe increases, and it becomes red, swollen and painful.

Sometimes new tissue starts growing over the toenail. Doctors call this a granuloma, because the surface of the new tissue looks a bit like tiny granules. The inflamed area may weep, bleed or release pus and smell bad – especially if bacteria get into the wound.

Causes and risk factors

The symptoms are caused when the edge of the toenail presses into the skin and continues to grow. If this edge injures the skin and the soft tissue underneath it, the toe can become infected.

The following factors make it more likely that a toenail will become ingrown:

• Cutting the toenail too short or rounding the edges
• Wearing tight shoes
• Having very sweaty feet
• Inheriting a certain toenail growth shape, such as “pincer” toenails, which are so curved that they look like part of a tube when seen from the tips of your toes
• Being very overweight (obese)
• Having diabetes or a condition that can cause water retention in your feet, such as heart or kidney failure, or chronic venous insufficiency in your legs
• Taking medication to treat cancer.

Prevalence and outlook

Ingrown toenails are common. 20 out of 100 people who see their family doctor because of foot problems have an ingrown toenail.

Teenagers and young adults often develop them. This is because they tend to sweat more, for instance due to hormonal changes during puberty or when doing sports. But ingrown toenails are common in older people, too. They may have a higher risk because of medical conditions such as diabetes. Also, many older people are less flexible, making it difficult for them to take care of their feet and toenails. Because toenails get thicker with age, it’s harder to cut them, too.

Doctors distinguish between three stages of severity:

• Stage 1: The nail has grown into the skin on the side. The skin hurts and has become inflamed.
• Stage 2: New, inflamed tissue (granuloma) has grown at the edges of the ingrown toenail. The tissue is weeping and producing pus.
• Stage 3: The skin around the toenail is chronically inflamed and keeps oozing pus. The granuloma has already started growing over the nail.

Ingrown toenails of various degrees of severity

Effects

Ingrown toenails usually become noticeable early on because they hurt. If treated in time, it's often possible to manage the inflammation on your own. It will then go away without any consequences.

But the inflammation can spread in people who have a weakened immune system and if bacteria infect the wound: That can cause an infection with pus around or under the entire nail. It is then advisable to see a doctor, especially if you also feel tired and have a fever, and the infection has spread along the toe and developed into cellulitis (an infection of deeper layers of skin).

Diagnosis

An ingrown toenail can be diagnosed without any complex examinations. Doctors take a close look at the affected toe, and ask about the symptoms and any possible causes.

Additional tests – like a blood test, for instance – may be needed if they think that the ingrown toenail has already led to complications, such as cellulitis.

Prevention

There are several ways to prevent ingrown toenails. Good foot care is important – especially cutting your toenails. It is best not to round the toenails on the edges, and to leave them long enough so that the corners of the nails can freely rest against the skin to the side of them.

Make sure that your shoes aren’t too tight and leave enough room for your toes. Open or “breathable” shoes help to prevent sweaty feet.

Treatment

The most suitable treatment for an ingrown toenail will depend on how severe it is. If the inflammation is mild and doesn’t hurt much, the toe can be soaked in a soapy footbath and then the sore part of the toe can be treated with antiseptic or anti-inflammatory tinctures, gels or creams. It is important to dry the foot thoroughly after the footbath, wait a while before putting on shoes, and avoid putting pressure on the ingrown toenail.

The use of special gutter splints or braces can also help the nails to grow freely again. A podiatrist (foot specialist) can help to apply these devices. If you have a higher risk of foot problems due to diabetes, you should talk with your doctor first. It is generally a good idea to see a doctor if these measures don't help or if the skin around the ingrown toenail is producing pus and is severely infected. Surgery is usually recommended in that case. Various surgical procedures and techniques may be considered.

Everyday life

An ingrown toenail can hurt a lot when you walk or stand. Open shoes and loose-fitting socks can reduce the pressure on the affected toe. At night, too, it’s best to give the toe enough room to move and make sure that the sheets aren’t right on top of it. If your bed has a footboard, you can hang the bottom of the sheets over it to leave space between your toe and the sheets.

Some people find it hard to take care of their own feet and toenails – for example, because they have difficulties reaching their feet due to problems with their joints. If you can’t – or would prefer not to – have someone you know help you out, you can seek professional care:

• As long as your feet and toenails are healthy, and you don’t have any risk factors like diabetes, you can have a professional pedicure to trim your nails and remove calluses. You have to pay for this kind of treatment yourself.
• If you already have health problems related to your feet, then medical care by a podiatrist is an option. Some treatments may then be covered by your health insurer – for example, if the ingrown toenail problems were caused by diabetes.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Information about health care in Germany can help you to navigate the German health care system and find a suitable doctor. You can use this list of questions to prepare for your appointment.

Sources

• Eekhof JA, Van Wijk B, Knuistingh Neven A, van der Wouden JC. Interventions for ingrowing toenails. Cochrane Database Syst Rev 2012; (4): CD001541. [PubMed: 22513901]
• Exley V, Jones K, O'Carroll G et al. A systematic review and meta-analysis of randomised controlled trials on surgical treatments for ingrown toenails part I: recurrence and relief of symptoms. J Foot Ankle Res 2023; 16(1): 35. [PMC free article: PMC10257290] [PubMed: 37301845]
• Heidelbaugh JJ, Lee H. Management of the ingrown toenail. Am Fam Physician 2009; 79(4): 303-308. [PubMed: 19235497]
• Mittenzwei B. Orthonyxiespangenbehandlung in der podologischen Praxis. Der Fuß 2018; Sonderheft: Arbeiten am Fuß: 6-15.
• Moll I. Duale Reihe Dermatologie. Stuttgart: Thieme; 2016.
• Schumpelick V, Bleese N, Mommsen U. Kurzlehrbuch Chirurgie. Stuttgart: Thieme; 2010.

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.