Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
The most important clinical decision with Toenail Grows Sideways: 7 Causes and Permanent Treatment Options isn’t which treatment to choose — it’s identifying which subtype you have first. Our podiatrists see patients treated for the wrong subtype for months before the correct diagnosis leads to full resolution. Call (810) 206-1402 — expert podiatric care across Michigan.
A toenail that grows sideways — curving into the surrounding skin — is more than a cosmetic annoyance. When nail plate growth deviates from its normal direction, it consistently injures the lateral nail fold, creating a cycle of pain, inflammation, infection, and recurrence. Understanding why it happens determines which fix actually works permanently.
Why Toenails Grow Sideways: Causes and Contributing Factors
| Cause | Mechanism | Which Toes | Treatment Direction |
|---|---|---|---|
| Improper nail cutting (too short, curved) | Cutting nail shorter than the lateral fold removes the straight edge that guides outward growth; rounded cuts train the nail edge to curve inward | Great toe (hallux) most common | Cut straight across; leave corners level with or slightly beyond the skin fold |
| Tight shoes / narrow toe box | Lateral shoe wall presses on the nail fold and distorts normal nail growth trajectory; forces the nail to curve into the skin | Great toe and 5th toe (pinched bilaterally) | Wide toe box shoes; avoid pointed toe; shoe fitting at later in the day |
| Genetic nail plate curvature | Intrinsically curved nail plate (pincer nail / incurvated nail); nail matrix produces a highly curved plate that spirals into the nail fold as it grows | Great toe; may affect multiple nails | Conservative offloading; orthotics; gutter splinting; matrix reshaping surgery |
| Trauma to nail matrix | Prior injury (stubbing, crush) disrupts matrix; altered growth trajectory; may produce permanently curved plate | Any toe; often the injured toe | Address matrix asymmetry; partial matrixectomy if nail border consistently ingrowing |
| Subungual exostosis (bone spur under nail) | Bone spur growing under the nail plate pushes the nail upward and distorts its trajectory; nail appears to grow sideways or distort at the end | Great toe distal phalanx | X-ray confirms; surgical excision of exostosis |
| Onychomycosis (fungal nail) | Fungal infection thickens and distorts the nail plate, causing irregular lateral growth and crumbling at the edges | Any nail; great toe most common | Treat the fungal infection first; nail may normalize once cleared |
| Hyperhidrosis (excess sweating) | Chronic moisture softens nail fold tissue; creates an environment where even a slightly angled nail edge penetrates the fold | Any nail in moist environment | Address hyperhidrosis; keep feet dry; antifungal powder prophylactically |
Treatment Options by Severity
| Severity | What’s Present | Treatment | Expected Outcome |
|---|---|---|---|
| Mild — early; no infection | Nail edge touching fold; tenderness; no drainage | Correct nail cutting technique; wider shoes; cotton wisping (tucking cotton under nail edge); dental floss technique | Resolves with technique correction in 1–2 nail growth cycles |
| Moderate — ingrown with inflammation | Nail embedded in fold; redness, swelling, pain; no pus | Warm soaks; gutter splint (tube placed along nail edge); partial nail avulsion in office | Office procedure resolves acute episode; recurrence common without phenol |
| Severe — infected | Pus, pyogenic granuloma (proud flesh), significant pain | Partial nail avulsion + phenol matrixectomy; oral antibiotics if spreading infection | Phenol matrixectomy is permanent — nail border will not regrow on treated side |
| Chronic / recurrent — pincer nail | Highly curved nail plate; repeated bilateral ingrowing | Bilateral phenol matrixectomy; nail matrix reshaping; nail bracing (Onyfix or similar) | Permanent correction; nail grows as a narrower, straight plate after bilateral matrixectomy |
Balance Foot & Ankle treats ingrown and sideways-growing toenails at Howell and Bloomfield Hills — from same-day office procedures to permanent matrixectomy solutions. Call (810) 206-1402.
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For a complete clinical overview: Toenail Problems Complete Guide — nail discoloration, ridges, fungus, and injury treated
When should I see a podiatrist for a toenail problem?
See a podiatrist if your nail is thick, discolored, painful, separating from the nail bed, or shows signs of infection. Most nail problems are very treatable when caught early.
What causes toenails to become thick and yellow?
Onychomycosis (fungal infection) is the most common cause, followed by psoriasis, trauma, aging, and poor circulation. A podiatrist can take a nail sample for accurate diagnosis.
Doctor Answer
What causes a toenail to grow sideways and how is it corrected?
Sideways toenail growth occurs when the nail plate deviates laterally or medially due to scarring of the nail matrix or nail bed, previous nail trauma, chronic nail compression from footwear, or onychogryphosis (ram’s horn nail). Ingrown nail edges create a similar sideways appearance where one border curves under the skin. Conservative management includes proper trimming technique, nail bracing devices to redirect growth, and wider footwear to reduce nail compression. Surgical nail plate realignment or matrixectomy of the deviated portion provides more definitive correction for severe cases.
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 made him one of the most-followed foot & ankle educators on YouTube.