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• An ingrown toenail develops when the edge of the nail grows into the surrounding skin, causing pain, redness, and sometimes infection.
• Most ingrown nails respond to a brief in-office procedure done with local anesthesia — no operating room required.
• For recurring ingrown nails, a permanent matrixectomy prevents that edge of the nail from growing back.
• Most clinics can fit acute ingrown nails into the day's or next day's schedule.
• Diabetic patients should never attempt home treatment — even minor ingrown nails can become serious infections quickly.

What are ingrown toenails?

An ingrown toenail occurs when the edge of the nail — most often the big toe — grows into the surrounding skin instead of out over it. The result is pain, redness, and inflammation along the side of the nail, and in many cases an infection that produces drainage. Some people develop ingrown nails once and never again; others have a nail shape that makes them prone to recurring ingrown nails on the same toe.

Causes range from improper trimming (cutting the nail too short or rounded) to tight shoes, to inherited nail curvature, to a single traumatic event like stubbing the toe. Athletes and people whose work keeps them in tight footwear are particularly affected. Children and teens with thicker nails can develop ingrown nails as well.

At Northwest Extremity Specialists, ingrown toenails are one of the conditions we treat most quickly. Most patients are evaluated and treated in the same visit, with the procedure taking about 15 minutes from start to finish. For patients with recurring ingrown nails on the same toe, a permanent matrixectomy procedure addresses the underlying nail edge so it can no longer grow back ingrown — a definitive fix.

See it in motion

What it feels like

Ingrown toenails are usually obvious to the patient. Signs include:

• Pain along one side of the nail, especially with shoe pressure
• Redness and swelling next to the nail edge
• A small area of skin that feels tender to touch
• Clear or pus-like drainage along the nail edge
• A sense of pressure or fullness in the toe
• Overgrown skin partially covering the nail edge in chronic cases
• Fever or red streaking up the foot in advanced infections (urgent)

Why it develops

Ingrown toenails develop from a combination of nail anatomy and external pressure:

• Cutting the nail too short or rounded at the corners instead of straight across
• Tight, narrow, or pointed shoes
• An inherited tightly curved nail shape
• Trauma — stubbing the toe or dropping something on it
• Sports that involve repetitive toe impact (running, kicking, soccer)
• Fungal nail infections that thicken and distort the nail plate

How we diagnose ingrown toenails

Ingrown toenails are diagnosed on visual inspection. Your provider will look at the affected nail edge, check for signs of infection, and ask about prior ingrown nails on the same toe. No imaging is required for routine cases. If you have diabetes or impaired circulation, additional evaluation of foot blood flow and protective sensation may be done. Most patients have both the diagnosis and the treatment done in a single visit.

Non-surgical care

For mild, first-time ingrown nails caught early — when there is no infection — conservative measures may resolve the issue:

• Warm-water soaks 2–3 times per day
• Gentle elevation of the nail edge with a small piece of cotton
• Wider, open-toed shoes during healing
• Topical or oral antibiotics for any infection
• Proper straight-across nail trimming going forward

Surgical care

Most ingrown toenails are treated with a brief in-office procedure under local anesthesia. The painful edge of the nail is gently removed, providing immediate relief. For patients who have had multiple ingrown nails on the same toe, the procedure includes a permanent matrixectomy.

• Partial nail avulsion — removal of the painful nail edge under local anesthesia (about 15 minutes)
• Chemical matrixectomy with phenol — destroys the small portion of nail-growth tissue at the treated edge so that part of the nail does not regrow (recommended for recurring ingrown nails)
• Surgical matrixectomy — surgical removal of the nail matrix at the treated edge for selected cases
• Drainage of any abscess at the time of nail removal

After an in-office nail procedure, most patients walk out the same day, usually in a roomy shoe or sandal. The toe is bandaged for a few days, soaks are continued at home, and most people return to regular activity within 24–48 hours. Full healing of the nail-fold tissue takes 2–4 weeks. After a permanent matrixectomy, the treated nail edge does not regrow, but the rest of the nail looks essentially normal once healing is complete.

When to see a specialist

• An ingrown nail that has lasted more than a few days despite warm soaks
• Any sign of infection — pus, increasing redness, warmth
• Recurrent ingrown nails on the same toe (a permanent fix is straightforward)
• An ingrown toenail in a diabetic patient — even mild cases
• Fever, red streaking up the foot, or worsening pain — call promptly

Ingrown toenail treatment is performed routinely by any of our board-certified podiatrists across all 8 clinics. Most patients are seen the same day or next day, including those who need a permanent matrixectomy to prevent recurrent ingrown nails on the same toe.

Frequently asked questions

• Fungal Nail Infection
  Thick, distorted nails are more prone to becoming ingrown
• Corns & Calluses
  Tight shoes that cause ingrown nails also cause corns
• Bunions
  Bunion-related shoe pressure can contribute to ingrown big-toe nails
• Diabetic Ulcers
  An untreated ingrown nail in a diabetic can become a serious wound