Ingrown Toenail — Causes, Treatment & Permanent Removal

✅ Medically reviewed by Dr. Thomas Biernacki, DPM — Board-Certified Podiatrist · Last updated April 6, 2026

Table of Contents

• What Is an Ingrown Toenail?
• Symptoms & Stages
• Causes & Risk Factors
• Home Treatment (Mild Cases)
• When to See a Podiatrist
• The In-Office Procedure
• Permanent Fix: Nail Matrixectomy
• Recovery Timeline
• How to Prevent Ingrown Toenails
• Ingrown Toenails & Diabetes
• Warning Signs
• FAQ
• Sources

What Is an Ingrown Toenail?

An ingrown toenail — medically called onychocryptosis — happens when the edge or corner of a toenail grows into the soft skin beside it, puncturing the skin fold and triggering pain, inflammation, and sometimes infection. It’s one of the most common toenail problems we treat at Balance Foot & Ankle, and the big toe is affected in the vast majority of cases.

The condition ranges from mildly annoying to extremely painful and infected. At the mild end, you might notice tenderness and slight redness along one side of the nail. At the severe end, the toe becomes red, swollen, and may drain pus — a sign that bacteria have entered through the break in the skin created by the nail edge. The good news is that treatment is straightforward: removing the offending nail border provides immediate relief, and a simple permanent procedure prevents recurrence in over 95% of cases.

Symptoms & Stages

Stage	Symptoms	Treatment Approach
Stage 1 (Mild)	Tenderness along the nail border; slight redness and swelling; no drainage	Home care: warm soaks, proper trimming, wide shoes
Stage 2 (Moderate)	Increased redness, swelling; clear or yellow drainage; pain with shoe pressure	Podiatrist visit recommended; possible antibiotics
Stage 3 (Severe)	Significant infection; granulation tissue (red, raw, bleeding tissue) growing over the nail edge; pus drainage; throbbing pain	Podiatrist visit required; in-office nail removal + antibiotics

Causes & Risk Factors

Improper nail trimming is the most common preventable cause. Cutting the nails too short or rounding the corners (instead of cutting straight across) leaves a sharp nail edge or spicule that grows into the skin fold as the nail advances. Many patients try to dig out the corner themselves, which often makes the problem worse by creating an even sharper edge deeper in the fold.

Nail shape and genetics play a significant role. Some people have naturally curved (involuted) nails that are more prone to growing into the skin. This inherited nail shape is the reason many patients get recurrent ingrown toenails despite proper trimming technique — the nail’s curvature is simply too pronounced for the nail fold to accommodate comfortably.

Footwear that’s too tight in the toe box compresses the toes together, pushing the skin into the nail edge. Shoes that are too narrow, pointed-toe shoes, and socks that are too tight all increase risk. This is particularly common in adolescents whose feet are growing rapidly but who may still be wearing outgrown shoes.

Other factors include trauma to the nail (stubbing the toe, dropping something on it), fungal nail infection (which thickens and distorts the nail plate), excessive sweating (which softens the skin and makes it easier for the nail to penetrate), and certain conditions like diabetes or peripheral vascular disease that impair healing and increase infection risk.

Home Treatment (Mild Cases Only)

Stage 1 ingrown toenails — those with mild tenderness and redness but no infection or drainage — can often be managed at home. These steps help the nail edge clear the skin fold as it grows forward.

Warm soaks: Soak the foot in warm (not hot) water with Epsom salt for 15–20 minutes, 2–3 times daily. This softens the skin and reduces inflammation, making it easier for the nail to release from the fold. Pat dry thoroughly after each soak.

Gentle lifting: After soaking, you can try placing a small piece of clean cotton or unwaxed dental floss under the ingrown corner to gently lift the nail edge away from the skin. Replace the cotton daily after soaking. This encourages the nail to grow over (rather than into) the skin fold.

Protect the toe: Wear shoes with a wide toe box to minimize pressure on the nail. Apply antibiotic ointment (Neosporin or Polysporin) and a bandage to prevent infection while the area heals. Avoid tight socks and pointed-toe shoes.

What NOT to do: Don’t try to perform “bathroom surgery” by aggressively cutting into the nail fold with scissors or nail clippers. This frequently worsens the problem by creating a sharp spicule deeper in the fold. Don’t ignore signs of infection (increased redness, swelling, drainage, or worsening pain) — once infection develops, home treatment alone is usually insufficient.

When to See a Podiatrist

You should see a podiatrist if the ingrown toenail is infected (redness, swelling, drainage), if home treatment hasn’t worked within 1–2 weeks, if the ingrown nail keeps coming back, if you have diabetes or peripheral vascular disease (any foot problem needs professional care), or if granulation tissue (red, raw, bumpy tissue) has developed along the nail edge.

At Balance Foot & Ankle, we see patients for ingrown toenails frequently — often on the same day they call. Dr. Daria Gutkin has particular expertise in gentle nail procedures and frequently treats patients who are anxious about the process. The procedure is far less painful than most patients expect — in fact, most report that the ingrown toenail itself was significantly more painful than the treatment.

The In-Office Procedure: What to Expect

The standard procedure for an ingrown toenail is a partial nail avulsion — removing the ingrown border of the nail under local anesthesia. Here’s exactly what happens:

Step 1: Numbing. We inject local anesthetic (lidocaine) at the base of the toe using a digital nerve block. This is the most uncomfortable part of the procedure — a brief pinch and burning that lasts about 15 seconds. Within 2–3 minutes, the entire toe is completely numb.

Step 2: Removal. Using a specialized instrument, we separate the ingrown nail border from the nail bed and remove it cleanly. This takes about 60 seconds. You won’t feel any pain — just some pressure. If there’s infection, we drain it at the same time. If granulation tissue has formed, we remove that as well.

Step 3: Dressing. We apply antibiotic ointment and a bandage. The entire procedure takes approximately 15 minutes from start to finish.

Immediate relief: Patients typically report dramatic pain improvement as soon as the offending nail edge is removed — even before the anesthesia wears off. Most patients walk out of the office on their own and return to normal activities within 1–2 days.

Permanent Fix: Nail Matrixectomy

For patients with recurrent ingrown toenails — those who have had the same nail border become ingrown multiple times — we recommend adding a chemical matrixectomy to the nail removal procedure. This permanently prevents the ingrown portion from regrowing.

After removing the ingrown nail border, we apply a small amount of phenol (a chemical cauterizing agent) to the nail matrix — the growth center at the base of the nail. The phenol destroys the matrix cells responsible for producing that specific portion of the nail, so it never grows back. The rest of the nail continues to grow normally. The cosmetic result is excellent — the nail appears slightly narrower than before, but the change is barely noticeable.

Success rate: Chemical matrixectomy with phenol has a permanent cure rate exceeding 95%. This means that in 19 out of 20 patients, the ingrown nail never returns. The rare recurrences can be re-treated with the same procedure.

Recovery Timeline

Timeframe	Partial Nail Avulsion (No Matrixectomy)	With Chemical Matrixectomy
Day 1	Mild soreness as anesthesia wears off; keep bandaged; rest and elevate	Same; mild drainage is normal from the phenol site
Days 2–3	Most patients back to normal activities; open-toe shoe may be more comfortable	Continue daily soaks and bandage changes; clear/yellow drainage normal
Week 1	Minimal discomfort; nail bed healing; can usually wear regular shoes	Drainage decreasing; continue daily wound care
Weeks 2–4	Fully healed; nail growing normally	Matrixectomy site healed; nail bed epithelialized
Months 2–4	Nail has regrown (may become ingrown again without matrixectomy)	Permanent result — treated portion does not regrow

How to Prevent Ingrown Toenails

Trim straight across: Cut your toenails in a straight line — do not round the corners or cut them into a curve. The corners of the nail should be visible above the skin fold. Use toenail clippers (not scissors or fingernail clippers) for a clean, straight cut.

Don’t cut too short: The nail should extend just to (or slightly past) the tip of the toe. Cutting nails too short allows the skin fold to close over the nail edge, setting the stage for the nail to grow into the skin as it advances.

Wear proper-fitting shoes: Ensure your shoes have adequate room in the toe box. You should be able to wiggle your toes freely. Replace shoes as they wear out — compressed toe boxes in old shoes increase pressure on the nails.

Keep feet clean and dry: Moisture softens the skin, making it easier for the nail to penetrate. Dry your feet thoroughly after showering, and change socks if they become sweaty. Moisture-wicking socks help reduce sweat accumulation.

Protect your toes: Wear protective footwear during sports and activities where toe injuries are likely. Even minor nail trauma can lead to abnormal nail growth and subsequent ingrown nails.

Ingrown Toenails & Diabetes

If you have diabetes, an ingrown toenail is never “just a minor problem.” Diabetes impairs blood flow and immune function in the feet, which means infections develop more easily, spread more quickly, and heal more slowly. An ingrown toenail infection that a healthy person might fight off in a few days can progress rapidly in a diabetic patient — potentially leading to cellulitis, osteomyelitis (bone infection), or in severe cases, amputation.

Critical rule for diabetic patients: Never attempt to treat an ingrown toenail at home. See a podiatrist at the first sign of redness or pain along the nail border. Do not use sharp instruments on your nails. Have your nails trimmed professionally during regular diabetic foot care visits. These precautions can prevent a minor nail problem from becoming a serious health threat.

Frequently Asked Questions

Does ingrown toenail removal hurt?

The most uncomfortable part is the numbing injection, which feels like a brief pinch and burn lasting about 15 seconds. Once the toe is numb (within 2–3 minutes), the actual nail removal is painless — you’ll feel pressure but no pain. After the anesthesia wears off (1–2 hours later), there’s mild soreness that’s easily managed with over-the-counter pain relief. The vast majority of patients say the procedure was far less painful than they expected, and that the ingrown nail itself was much worse than the treatment.

How long does recovery take?

Most patients return to normal activities within 1–2 days after a simple nail removal. If a matrixectomy was performed, the site may drain slightly for 2–3 weeks during healing, but this doesn’t prevent normal activity. You can shower the next day (just pat dry and reapply the bandage) and wear regular shoes within a few days. Running and heavy exercise should be avoided for about a week.

Will the ingrown nail come back?

Without matrixectomy, there’s a significant chance of recurrence — the same nail curvature that caused the first ingrown toenail will likely cause another. With a chemical matrixectomy (phenol application), the permanent cure rate exceeds 95%. This is why we typically recommend matrixectomy for any patient who has had more than one episode of the same ingrown nail. The cosmetic result is excellent — the nail is slightly narrower but looks completely natural.

Can I treat an infected ingrown toenail at home?

Once an ingrown toenail is infected (redness, swelling, drainage), home treatment alone is unlikely to resolve it. The nail edge is acting as a foreign body embedded in the skin — until it’s removed, the infection has an ongoing source. Antibiotics may temporarily control the infection, but it typically recurs as long as the nail edge remains in the skin. The most effective treatment is removing the ingrown nail border in the office, which eliminates the source of infection and allows antibiotics to work effectively.

Sources

• Eekhof JA, Van Wijk B, Knuistingh Neven A, van der Wouden JC. Interventions for ingrowing toenails. Cochrane Database Syst Rev. 2012;(4):CD001541.
• Heidelbaugh JJ, Lee H. Management of the ingrown toenail. Am Fam Physician. 2009;79(4):303-308.
• Bos AM, van Tilburg MW, van Sorge AA,”;”;”;”;”; “; “; “; “; van der Heijden JP. Randomized clinical trial of surgical technique and local antibiotics for ingrowing toenail. Br J Surg. 2007;94(3):292-296.
• Haneke E. Controversies in the treatment of ingrown nails. Dermatol Res Pract. 2012;2012:783924.

The Bottom Line

An ingrown toenail is one of the most common — and most easily treated — foot problems. Mild cases may respond to home care with warm soaks and proper trimming technique. But once infection develops, or if the problem recurs, a quick in-office procedure provides immediate relief with minimal downtime. For patients tired of dealing with recurrent ingrown nails, a chemical matrixectomy offers a permanent solution with over 95% success rate. The procedure is faster, less painful, and simpler than most people imagine — and the relief is immediate.

Clinical References

1. Eekhof JA, Van Wijk B, Knuistingh Neven A, van der Wouden JC. Interventions for ingrowing toenails. Cochrane Database Syst Rev. 2012;(4):CD001541.
2. Heidelbaugh JJ, Lee H. Management of the ingrown toenail. Am Fam Physician. 2009;79(4):303-308.
3. Bos AM, van Tilburg MW, van Sorge AA, van der Pol JP. Randomized clinical trial of surgical technique and local antibiotics for ingrowing toenail. Br J Surg. 2007;94(3):292-296.