What causes ingrown toenails?

Ingrown toenails can develop from a combination of mechanical pressure, improper grooming habits and individual nail or foot characteristics. The condition usually starts when the nail edge repeatedly presses into the surrounding skin, leading to pain and inflammation. Over time, this irritation worsens and may cause infection if not addressed early.

• Improper nail trimming — cutting toenails too short or rounding their corners makes it easier for the nail edge to grow into the skin.
• Tight or narrow footwear — shoes that squeeze the toes or exert constant pressure on the nail fold can cause the nail to curve inward.
• Toe injuries — stubbing the toe, dropping a heavy object on it or repetitive trauma during sports can distort normal nail growth.
• Genetic or structural factors — people with naturally curved, thick or wide nails are more prone to developing ingrown toenails, as are those with foot deformities such as bunions.
• Excessive moisture or sweating — constant dampness softens the surrounding skin, making it more vulnerable to penetration by the nail edge.
• Poor foot hygiene — neglecting regular cleaning or wearing unventilated shoes for long periods increases the risk of irritation and infection.

How does an ingrown toenail look like?

An ingrown toenail usually appears as a curved or sharp nail edge pressing into the side of the toe, most often the big toe. The surrounding skin becomes red, swollen and tender to touch. In mild cases, you may notice slight soreness or inflammation, but when infection develops, the area can turn warm and produce yellowish pus or fluid. The skin around the nail may thicken or form soft, overgrown tissue, and wearing shoes can become painful due to pressure on the affected toe.

What are the signs and symptoms of an infected ingrown toenail?

An ingrown toenail may start as mild discomfort but can quickly become painful and inflamed if infection develops. Recognising the early signs helps prevent the problem from worsening and reduces the need for more invasive treatment.

• Pain and tenderness — the skin around the affected nail becomes sore, especially when pressure is applied or when shoes rub against the toe.
• Redness and swelling — the area may appear red, puffy and warm to the touch, indicating local inflammation.
• Pus or discharge — infected ingrown toenails often produce yellowish fluid or pus, sometimes accompanied by a foul smell.
• Bleeding or overgrown tissue — in more advanced cases, soft granulation tissue may form around the nail edge, which bleeds easily and traps bacteria.
• Difficulty walking or wearing shoes — severe pain may make it hard to walk comfortably, especially in closed footwear.
• Spreading infection — if left untreated, the infection can extend deeper into the skin or surrounding tissue, which is particularly concerning for people with diabetes or poor circulation.

Who is more likely to develop an ingrown toenail?

Anyone can experience an ingrown toenail, but certain people are more prone to it because of their foot shape, lifestyle or medical conditions. Understanding who is at higher risk can help with prevention and early care.

• Active individuals — runners, footballers and those who spend long hours on their feet are more likely to develop ingrown toenails due to repeated pressure and friction on the toes.
• People with curved or thick nails — a naturally curved nail shape makes it easier for the edges to dig into the skin as the nail grows.
• Those who wear tight footwear — shoes that crowd the toes or have narrow fronts increase pressure on the nail folds, encouraging inward nail growth.
• Individuals with foot deformities — conditions such as bunions, hammertoes, or flat feet can alter toe alignment, making nails more susceptible to becoming ingrown.
• People with diabetes or poor circulation — reduced blood flow and nerve sensitivity make the feet more vulnerable to infections and slower to heal after irritation or minor injuries.
• Teenagers and young adults — rapid nail growth and active lifestyles make this group more susceptible, especially when combined with improper nail trimming or footwear choices.

Complications of an ingrown toenail

If an ingrown toenail is left untreated, it can lead to infection, persistent pain and tissue overgrowth around the nail. In severe or recurrent cases, the infection may spread to the underlying bone or surrounding skin. People with diabetes, nerve damage or poor circulation face a higher risk of slow healing and serious complications. Prompt medical treatment helps prevent these issues and supports healthy nail regrowth.

How is an ingrown toenail diagnosed?

A proper diagnosis helps determine how severe the ingrown toenail is and whether infection is present. During your consultation, our podiatrist will examine the affected toe closely, checking for redness, swelling, pus and tenderness along the nail edge. The goal is to assess how deeply the nail has grown into the surrounding skin and whether any abscess or hypergranulation tissue has formed.

• Clinical examination — most cases are diagnosed through a simple physical assessment. The podiatrist may gently lift the nail edge to check the extent of skin involvement and look for signs of infection or ingrown nail curvature.
• Medical history — you may be asked about recent toe injuries, footwear habits, nail-trimming techniques or underlying conditions such as diabetes or circulation problems that can slow healing.
• Assessment for recurring or chronic cases — for people with repeated ingrown toenails, the doctor may evaluate nail shape, foot alignment and footwear choices to identify contributing factors.

A timely and accurate diagnosis ensures that the right treatment plan is chosen, whether conservative care, minor nail surgery, or infection management to relieve pain and prevent recurrence.

How are ingrown toenails treated? 

The right treatment for an ingrown toenail depends on how severe the condition is and whether infection has developed. Early cases can often be managed conservatively, while advanced or recurring cases may need a minor procedure to remove part or all of the affected nail. The goal is to relieve pain, prevent infection, and reduce the chance of recurrence.

• Slant back cut — in the early stages, the podiatrist may perform a gentle ‘slant back cut’, trimming the corner of the nail to lift it away from the skin. This allows the nail to grow out properly while easing discomfort and inflammation.
• Onyfix nail bracing (pain-free) — Onyfix is a specialised nail correction system used to treat curved or ingrown toenails without pain or surgery. A thin, customised brace is applied to the nail surface, which gradually guides the nail back to its natural shape as it grows. The treatment is gentle, non-invasive and does not require cutting or anaesthesia.
• Conventional nail bracing — where appropriate, thin corrective braces (non-Onyfix) can be used to flatten excessive curvature and guide safe nail growth, lowering recurrence risk.
• Partial nail avulsion — when the edge has embedded deeply or infection is present, the ingrown portion is removed under local anaesthetic; a chemical (e.g., phenol) may be applied to the exposed matrix to prevent that edge regrowing and reduce recurrence.
• Total nail avulsion — for severe deformity or repeated relapse, the whole nail is removed under local anaesthetic; matrix cautery may be performed to stop problematic regrowth where indicated.

Our experienced podiatrists will assess your condition carefully and recommend the most suitable approach to restore comfort and healthy nail growth. If you are experiencing persistent pain or swelling around the toenail, schedule a consultation to discuss your treatment options.

Prevention tips for ingrown toenails

Simple foot care habits can go a long way in preventing ingrown toenails and avoiding future discomfort. Following these podiatrist-recommended practices will help maintain healthy nail growth and reduce the risk of infection.

• Trim your toenails straight across — avoid cutting toenails in a curved shape, as this encourages the edges to grow into the skin. If you have trouble trimming your nails or have poor circulation in your feet, schedule regular visits with a podiatrist for safe nail care.
• Keep toenails at a moderate length — nails that are too short increase the risk of the surrounding skin growing over the edge of the nail. Trim them so that they are level with the tips of your toes.
• Wear shoes that fit properly — tight or narrow footwear places unnecessary pressure on the toes, forcing the nail edge into the skin. Choose shoes that allow enough space for your toes to move freely and avoid pinching at the front.
• Select appropriate footwear for your activities — if your work involves heavy objects or risk of injury, wear protective shoes such as steel-toed boots. For those with sweaty feet, opt for open-toed or breathable footwear to reduce moisture build-up.
• Check your feet regularly — inspect your feet and toenails often, especially if you have diabetes or reduced sensation in your toes. Early detection of redness, swelling, or tenderness can prevent minor irritation from turning into an infection.

Summary

Ingrown toenails are a common but painful condition where the edge of the nail grows into the surrounding skin, most often affecting the big toe. They can cause redness, swelling, tenderness, and in some cases, infection. Common causes include improper nail trimming, tight footwear, repeated trauma and naturally curved toenails. Certain individuals, such as active adults, teenagers, and people with diabetes are more prone to developing this problem due to pressure, moisture, or circulation issues.

An infected ingrown toenail can lead to significant pain, pus formation or tissue overgrowth if left untreated. Diagnosis is usually made through a physical examination by a podiatrist, who will assess the extent of nail involvement and infection. Treatment options vary depending on severity, ranging from simple trimming and nail bracing to partial or total nail avulsion for recurring or severe cases. Preventive care is equally important: trimming nails straight across, wearing properly fitted shoes and checking feet regularly can help reduce the risk of recurrence.

If you are experiencing persistent pain, swelling or signs of infection around your toenail, schedule a consultation with Atlas Podiatry for professional assessment and effective treatment to restore comfort and prevent future problems.