Why Ingrown Toenails Develop

An ingrown toenail occurs when the edge of the nail plate grows into or is pressed against the surrounding skin of the nail fold, causing pain, redness, and sometimes infection. The great toenail is overwhelmingly the most common site. Multiple factors contribute: incorrect nail trimming technique (cutting nails too short or in a curved arc rather than straight across), shoes that are too narrow in the toe box that compress the nail into the flesh, naturally curved nail shapes, nail trauma (from dropping objects, stubbing, or repetitive microtrauma from running), and hyperhidrosis (excessive foot sweating that softens the skin around the nail).

Stages of Ingrown Toenail Severity

Stage 1 (mild): Redness, swelling, and pain at the nail fold without discharge. The nail is pressing into the skin but not yet puncturing through. Home care is appropriate at this stage. Stage 2 (moderate): Wound infection with purulent discharge (pus), increased swelling and redness, and skin overgrowth (hypergranulation tissue) developing at the nail edge. Professional treatment is needed. Stage 3 (severe): Chronic infection with significant granulation tissue, hypergranulation, and nail deformity. Recurrent infections despite repeated conservative treatment. Definitive nail procedure is indicated.

Correct Nail Trimming Technique

The most powerful prevention tool is proper nail trimming. Cut nails straight across — never curved. Leave the nail edge at the level of the toe tip or slightly longer — do not cut below the end of the nail bed. Do not attempt to dig out “corners” — leaving the corners alone and trimming only the free edge prevents the nail from embedding. Use proper nail clippers designed for toenails (wider jaw) rather than fingernail clippers. Trim nails every 4–6 weeks. For nails that are too thick or curved to cut safely, professional podiatric nail care is appropriate.

Home Care for Stage 1 Ingrown Toenails

Soak the foot in warm water with Epsom salt 15–20 minutes twice daily to soften the skin and reduce inflammation. Gently lift the ingrown nail edge and place a small wisp of cotton or dental floss underneath to separate the nail from the skin — this technique reliably reduces pain and allows the nail to grow beyond the skin edge. Wear open-toed or very wide-toed footwear until the acute inflammation resolves. Over-the-counter ingrown toenail products (Dr. Scholl’s, etc.) provide temporary relief. Topical antibiotic ointment on the inflamed area reduces superficial bacterial load. Most Stage 1 ingrown toenails resolve with these measures within 1–2 weeks.

Professional Treatment: The Partial Nail Avulsion

Stage 2 and 3 ingrown toenails require professional treatment. The standard in-office procedure is partial nail avulsion: after anesthetic injection into the toe, the ingrown edge of the nail (typically 3–5 mm of the nail’s lateral portion) is cut from base to tip and removed. The procedure is essentially painless after the anesthetic and takes 5–10 minutes. When the nail repeatedly ingrows at the same edge, a permanent solution is added: phenol matrixectomy destroys the nail root cells (matrix) at the treated edge with a chemical application, permanently preventing regrowth of that narrow strip of nail while leaving the central nail intact. The permanent procedure has a 95%+ success rate. Recovery requires simple wound care for 1–3 weeks with normal footwear and activities. Diabetic patients and immunocompromised individuals should seek professional treatment immediately for any ingrown toenail without attempting home care. Call Balance Foot & Ankle at (810) 206-1402 for same-day or next-day ingrown toenail appointments.

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.