Ingrown Toenails

Ingrown Toenails

What Are Ingrown Toenails?

Ingrown toenails are a common soft tissue condition of the feet and often occur due to either the way the toenail is cut or the natural anatomy of the nail. Some treatments for ingrown toenails include partial or total nail removal which will be done under local anaesthesia.

Regardless of the reason for the occurrence, generally, the nail will slowly grow into the flesh of the nail fold, causing a small break in the skin. This break in the skin, while initially may not be felt by the patient, becomes a portal of entry for the bacteria to creep in. As more bacteria opportunistically enter the soft tissue, the body reacts to this by flaring up with inflammation, warmth, redness and sometimes purulence (pus). 

If only oral antibiotics are taken or antibiotic ointment is applied, the surrounding nail fold will remain infected as the aggravating factor has not been removed.

Causes of Ingrown Toenails

Ingrown toenails are generally caused by the way you trim your nails or a change in the shape of the toenails. Individuals with toenails that are either highly curved, known as involuted nails, or very wide nail plates, are at high risk of developing ingrown toenails at some point in life. Without proper treatment, it may even lead to recurrent ingrown toenails.

Common causes of ingrown toenails include:

  •         Trauma to the toenail (e.g stubbed toe, stepped on by others)
  •         Cutting toenails in a curved manner (“rainbow-shaped”)
  •         Tight-fitting footwear
  •         Picking the nails


Factors that can lead to change in nail shape:

Ingrown Toenail Signs & Symptoms

  • Nail edge that curves into the sides of the skin
  • Painful, inflamed nail fold with surrounding redness, warmth, and pus on occasion.
  • Bleeding from the sides of the affected nail
  • Pain when wearing enclosed footwear
  • Sometimes an extra piece of “flesh” grows out, also known as a pyogenic granuloma.

Ingrown Toenail Treatment

Ingrown toenails can be treated conservatively or through a minimally invasive procedure. The procedure, known as partial nail avulsion with matrixectomy, can be performed to provide a long-term resolution. It is important to understand the cause of the ingrown toenail and its likelihood of recurrence before deciding the best treatment option.

Ingrown toenail treatment options include:

  • Partial or total nail avulsions, done under local anaesthesia
  • Conservative trimming of the nail spike for short-term pain relief
  • Antiseptic foot soaks to prevent infections
  • Proper wound care daily if there is active bleeding or discharge
  • Customised foot orthoses may be considered if flat feet or bunions are present

Ingrown Toenail Prevention

Repeated episodes of ingrown toenails can easily happen once you have had it before, therefore it is essential to know how to prevent an ingrown toenail from occurring.

Steps that you can do to prevent ingrown toenails from developing include:

  • Avoid tight-fitting footwear
  • Cutting nails straight across and not curved down the edges
  • Round any sharp nail edges with a file after each trim


Things you should do when you have an ingrown toenail:

  • Avoid doing pedicure
  • Do not attempt to pick or pull out any nail spikes yourself
  • Keep the area covered with an antiseptic dressing
  • Seek medical attention if the area becomes red, swollen, or pus is seen


Improper handling of an ingrown toenail can result in serious infection, especially in patients with low immunity. Many patients often neglect the condition in its early stages and ended up with severe pain and pus collection at the side of the affected nail.

When Should I Consult a Podiatrist?

  • If you experience pain and swelling at the sides of the toenails
  • If you have been suffering from repeated episodes of possible ingrowing toenail
  • If you are seeking a long-term resolution to your ingrown toenail

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