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A Guide to the Causes of Ingrown Toenails

The Most Common Nail Problem: Onychocryptosis

Ingrown toenails (medically known as Onychocryptosis) are one of the most common reasons people visit a Podiatrist. There are many possible causes, but the problem is almost always the same: the side of the nail cuts into the delicate skin next to it. This acts like a splinter, causing pain, inflammation, and often infection.

What is an Ingrown Toenail?

An ingrown toenail occurs when the nail plate grows into the periungual skin (the skin surrounding the nail) instead of over it (Heidelbaugh & Lee, 2024). It is very common, particularly in teenagers and young adults, though it can affect anyone at any age.The body treats the nail piece piercing the skin as a "foreign body," similar to a splinter or piece of glass. This triggers an inflammatory reaction as the body tries to attack the intruder.Symptoms and Signs: The symptoms are very distinct. People usually feel a sharp, throbbing pain at the side of the toe.

The Stages of an Ingrown Toenail

The NHS and UK Podiatry services generally classify the severity of an ingrown toenail into three distinct stages. Identifying which stage you are at helps determine the right treatment (NHS inform, 2025).

Stage 1: Inflammation The nail has curled into the skin but has not yet broken through the dermis.Symptoms: There is redness (erythema) and mild swelling along the side of the nail. It feels sore to the touch or when wearing tight shoes, but there is no pus or bleeding (Mayeaux & Carter, 2025).

Stage 2: Infection The nail has spiked and physically pierced through the skin, creating an open wound.Symptoms: The toe becomes visibly infected. You will see increased redness that may spread, significant swelling, and the wound will often weep clear fluid, bleed easily, or produce yellow/white pus. The pain is usually sharp and throbbing (NHS inform, 2025).

Stage 3: Chronic Infection (Hypergranulation) The condition has been present for a longer time, and the body is trying to heal over the nail.Symptoms: Alongside chronic inflammation and pus, you will see the growth of "extra skin" (known as hypergranulation tissue). This red, cauliflower-like tissue grows over the nail plate and bleeds very easily (Reilly, 2021). At this stage, antibiotics alone are rarely effective as the foreign body (the nail) remains embedded (Mayeaux & Carter, 2025).

Some Potential Causes

Just like heel pain, ingrown toenails don't just happen. They are usually caused by a combination of outside factors and your natural foot shape.

FootwearPoor footwear is a major, and fixable, problem. Shoes that are too tight, narrow, or shallow (like pointed-toe heels or tight football boots) squeeze the toes together. This pressure forces the skin into the nail plate (Bryant & Knox, 2015).

Poor Toenail CuttingImproper trimming is the most common cause. Cutting the nails too short or, crucially, cutting down the sides of the nail to "relieve pressure" often leaves a small spike (spicule) of nail hidden in the corner. As the nail grows, this spike pierces the skin.

Hereditary (Nail Shape)Sometimes, it is simply bad luck. The shape of your nail is genetic. Some people have nails that are naturally very curved (involuted) or wide ('fan shaped'), making them much more likely to grow into the skin regardless of footwear (StatPearls, 2025).

TraumaStubbing your toe or dropping something on it can damage the nail matrix (the root), causing the nail to grow out thicker or deformed, leading to ingrowth.

At Clinical Touch Podiatry we specialize in managing and getting rid of the pain from ingrown toenails using evidence based treatments. Book a Nail Care visit today!

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Treatment Options

Treatment depends on how severe the problem is. We categorize treatments into Conservative Management and Surgical Options.

Conservative ManagementFor mild cases (Stage 1), where there is no severe infection or extra skin growth, simple measures can help.Clearing the sulci: A podiatrist can professionally clear debris and carefully remove the offending spike of nail without cutting the skin.Offloading: This involves assessing footwear, using insoles, or using padding or toe covers to relieve pressure on the nail.Antibiotics: Note: Antibiotics alone cannot cure an ingrown toenail. They treat the infection, but if the nail spike (the "splinter") is still in the skin, the infection will return as soon as the antibiotics stop (Heidelbaugh & Lee, 2024).

Nail Surgery OptionsWhen conservative care fails, or the condition keeps coming back, a small surgical procedure is often the permanent solution.While we do not perform surgical procedures at Clinical Touch Podiatry, we are experts in assessing the severity of your condition. If surgery is required, we will refer you directly to a trusted Nail Surgery Specialist to perform the following procedures:

Partial Nail Avulsion (PNA) with Chemical MatrixectomyThis is widely considered the "Gold Standard" treatment for ingrown toenails (Exley et al., 2023).The Procedure: The specialist will numb the toe with a local anaesthetic so you feel no pain. They then remove only the small section of nail that is digging into the skin. The whole toenail does not usually need to be removed.Chemical Matrixectomy: Once the nail piece is removed, a chemical (Phenol) is applied to the root. This kills the nail-producing cells in just that corner.The Result: The nail heals slightly narrower but looks normal, and the ingrown edge can never grow back. This procedure has a success rate of over 95% (Exley et al., 2023).

Total Nail Avulsion (TNA)In cases where the nail is extremely thick, damaged, or fungal, the specialist may recommend removing the entire nail. The skin heals over the nail bed, leaving a normal-looking toe without a nail plate.

At Clinical Touch Podiatry we specialize in the assessment and conservative management of ingrown toenails. If we cannot resolve the issue conservatively, we will refer you to a specialist surgeon to ensure the pain is removed permanently.

References

Bryant, A., & Knox, A. (2015). Ingrown toenails: The role of the GP. Australian Family Physician, 44(3), 102–105. https://www.racgp.org.au/afp/2015/march/ingrown-toenails-the-role-of-the-gp

Exley, V., Jones, K., O'Carroll, G., Watson, J., & Backhouse, M. (2023). A systematic review and meta-analysis of randomised controlled trials on surgical treatments for ingrown toenails. Journal of Foot and Ankle Research, 16(1). https://doi.org/10.1186/s13047-023-00631-1

Heidelbaugh, J. J., & Lee, H. (2024). Management of the ingrown toenail. American Family Physician, 83(3), 200–208. https://www.aafp.org/pubs/afp/issues/2011/0201/p307.html

Mayeaux, E. J., & Carter, C. (2025). Ingrown toenail (onychocryptosis). In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK546697/

NHS inform. (2025). Ingrown toenail. National Health Service. https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/ingrown-toenail/

Reilly, I. (2021). Toenail surgery: Indications, options and techniques. The Podiatrist, 24(2), 12–15. https://www.scribd.com/document/674484161/Reilly-Toenailsurgery-Indicationsoptionsandtechniques

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