An ingrown toenail — where the edge or corner of the nail grows into the surrounding skin — is one of the most common and most painful podiatric conditions, affecting an estimated 20% of patients who present to foot clinics with nail complaints. While mild cases can be managed at home, infected, severely painful, or chronically recurrent ingrown toenails require professional treatment — and attempting home surgery on an ingrown toenail is one of the most common ways patients end up in our offices with a significantly worse problem than they started with. Dr. Tom Biernacki, DPM at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan evaluates and treats all stages of ingrown toenail, including permanent correction for chronically recurrent cases.

What Causes Ingrown Toenails?

Ingrown toenails develop from a combination of genetic nail shape, improper trimming technique, and external pressure. Curved or involuted nail plates — where the nail edges curl downward into the surrounding tissue — are strongly heritable. The big toe (hallux) is involved in 85–95% of cases. Improper trimming — cutting the nail in a curved arc following the toe tip rather than straight across, or cutting too short at the corners — is the most modifiable risk factor. Tight footwear that compresses the nail edges into the skin is a major contributor, as is nail trauma (stubbing the toe, dropping objects on the nail).

Adolescents and young adults are disproportionately affected, likely because of activity levels, footwear choices (tight athletic shoes, cleats), and improperly learned trimming habits. Older patients develop ingrown toenails from progressive nail thickening and curvature with age, combined with difficulty reaching and properly trimming nails.

Stages of Ingrown Toenail Severity

Stage 1 (Mild): Pain, swelling, and redness at the nail edge without infection or drainage. The nail edge is beginning to impinge on the skin but has not broken through. Stage 1 can be managed conservatively: warm soaks 10–15 minutes twice daily (softens the skin and reduces swelling), proper straight-across nail trimming, and cotton-tucking (placing a small wisp of cotton or dental floss under the offending nail edge to redirect growth away from the skin). Wide, open-toed footwear reduces pressure.

Stage 2 (Moderate — Infected): The nail edge has pierced the skin, with purulent (pus) drainage, increased swelling, and spreading redness. Stage 2 requires professional treatment. Home management at this stage is ineffective and risks spreading cellulitis. Podiatric treatment involves a digital block (local anesthetic), partial nail border avulsion (removing the offending nail edge to the nail base), and wound care with or without oral antibiotics depending on the extent of infection. This procedure takes 10–15 minutes in-office and provides immediate relief.

Stage 3 (Chronic — Granulation Tissue): Recurrent or untreated ingrown toenails develop exuberant granulation tissue (hypergranulation) — a fleshy, red overgrowth of tissue that bleeds easily and cannot be resolved without treatment. Stage 3 typically requires partial nail avulsion combined with silver nitrate cauterization or ablation of the granulation tissue, followed by permanent nail border removal (matrixectomy) if the patient wants to prevent future recurrence.

Permanent Ingrown Toenail Correction: Matrixectomy

Matrixectomy is the permanent removal of one or both nail borders — achieved by destroying the nail matrix (the growth plate at the base of the nail) with phenol or sodium hydroxide chemical ablation. The procedure is performed under digital block local anesthesia and takes 15–20 minutes. The nail border never regrows — providing permanent resolution for patients with chronically recurrent ingrown toenails without the need for any future procedures.

The phenol matrixectomy has a 95%+ success rate in the published literature and is the most cost-effective treatment for recurrent ingrown toenails. The treated nail border is narrower than the original nail by 2–4mm (the width of the removed border), which is cosmetically imperceptible in most cases. Recovery involves daily wound care with antiseptic solution for 2–4 weeks; the nail fold heals completely and patients return to normal shoe wear within 1–2 weeks for most cases.

Ingrown Toenail Home Care: What Is Safe and What Is Not

Safe home care for Stage 1 ingrown toenails: warm soaks, cotton-tucking technique, wide footwear, and straight-across trimming (never round the corners). What is not safe: digging under the nail edge with scissors or nail clippers to “cut out” the ingrown edge (this almost always removes the wrong tissue, leaves a nail spicule that causes a worse recurrence, and risks infection); applying nail hardening or nail polish remover to the nail (causes skin damage); and “bathroom surgery” of any kind on an already infected toenail.

The Most Common Ingrown Toenail Mistake

The most common mistake: cutting a V-notch in the center of the toenail to “relieve pressure.” This is a widespread home remedy myth — there is no mechanism by which a V-notch at the distal free edge of the nail reduces pressure at the lateral nail border. The nail does not “grow toward” the notch. This technique does nothing for the ingrown nail and wastes time during which the infection can progress. Correct approach: straight-across trimming, cotton-tucking for Stage 1, and podiatric evaluation for Stage 2–3.

Warning Signs — Same-Day Evaluation Required

Seek same-day evaluation for: any ingrown toenail in a diabetic patient (infection spreads rapidly and without pain in neuropathic feet — a medical urgency); red streaking up the toe (lymphangitis — infection spreading to lymphatic system, requires same-day antibiotics); fever with an ingrown toenail (systemic sepsis requires immediate evaluation); or any ingrown toenail in a patient with poor circulation (peripheral artery disease — compromised wound healing requires immediate specialist management).

Book Same-Day Treatment — Howell & Bloomfield Hills

Dr. Tom Biernacki, DPM performs same-day ingrown toenail treatment including partial nail avulsion and permanent matrixectomy at both Balance Foot & Ankle locations. We hold specific same-day slots for acute ingrown toenail cases. Call by 9:00 AM for same-day availability: (810) 206-1402. Or request an appointment online. Serving Howell, Brighton, Bloomfield Hills, Troy, and all of southeastern Michigan.

Related: Black Toenail · Corns & Calluses · Diabetic Foot Wound Care

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.