Your concern
Ingrown toenail
Onychocryptosis: the nail edge digs into the skin, and a curved cut makes it worse.
It almost always involves the big toe, and the mechanism is simple: the lateral edge of the nail plate penetrates the soft tissue, which reacts with inflammation, pain and sometimes granulation tissue that bleeds easily. Walking becomes uncomfortable, closed shoes unbearable.
The contributing factors are few and almost all correctable: tight or pointed footwear, excessive sweating that macerates the skin, repeated trauma in sport and — the commonest of all — the way the nail is cut.
And here lies the useful information, because almost everyone does the opposite of what is needed. Faced with a painful edge, the instinct is to cut it shorter and round it off. But that removes precisely the portion of nail that, growing, would have pushed outwards, leaving a spike that will grow back into the skin. Toenails should be cut straight across, without digging out the corners. It is a mundane correction that, repeated, prevents most recurrences.
Cut straight, not curved
This is the correction that prevents more recurrences than any treatment, and it runs opposite to instinct. Rounding the nail and digging out the painful corner gives relief for a few days, but removes the part of the plate that would have guided growth outwards: what grows back is a spike, and the spike re-enters the skin. Cutting straight across, leaving the corner visible and not beyond the fingertip, is what breaks the cycle. If the edge is already inflamed, though, this is not the moment to act alone.
How it shows
- Pain at the lateral edge of the nail, typically the big toe
- Redness and swelling of the adjacent tissue
- Pain on pressure from footwear
- Raised tissue that bleeds easily
- Discharge or odour in inflamed cases
- Systematic recurrence after each cutting
How we proceed
- 1Visit: degree of inflammation, presence of granulation tissue, state of the nail plate
- 2Management of the acute phase before any procedure
- 3Outpatient treatment under local anaesthetic, where indicated
- 4Correction of causes: cutting, footwear, sweating
- 5Review of healing and prevention of recurrence
Available treatments
- Dermatology visit
- Outpatient treatment
- Correction of causes
- Post-operative follow-up
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Frequently asked questions
Can I remove the painful piece myself?+
This is the move that brings most patients to the clinic with a worse picture than they started with. Digging out the corner with scissors or tweezers at home almost always leaves a splinter of nail inside the tissue, which goes on irritating it, and adds the risk of infection in an already inflamed area. The relief is brief and the problem returns larger.
It comes back every time: can it be resolved definitively?+
When recurrences are repeated, a procedure acting on the nail edge rather than only on the current episode is considered: it is done in the clinic, under local anaesthetic. It is a decision taken after seeing how often it has happened and why, because in a proportion of cases correcting the cutting and the footwear alone is enough to break the cycle without surgery.
How do I know if it has become infected?+
The signs are pain that increases instead of easing, swelling spreading beyond the nail edge, warmth, and the appearance of discharge. In that case assessment should not be postponed, especially in people with diabetes or circulatory problems in the legs: there, even a small lesion warrants more attention than average.
Related reading
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