An ingrown toenail (onychocryptosis) happens when part of the nail pierces the skin, often leading to an infection

The term ingrown toenail describes the piercing of the skin surrounding a toenail by the nail itself. It can occur on one or both sides of the toenail, and can affect one or both feet. For most people, this will occur in the big toe (hallux), though it can affect the lesser toes too. Once the nail penetrates the skin, the toe becomes vulnerable to complications like infection.

Ingrown toenails are often easy to identify because of the marked swelling at one or more sides of the nail combined with significant pain for those affected. Common symptoms include:

Redness
Tenderness
Swelling/inflammation
Mild to severe pain on touch
Occasional bleeding at the pierced site
Yellow/clear/green discharge if an infection is present

In severe cases, it will become difficult to wear shoes or have anything touching the toe, even something as light as a sheet in bed.

There is no single cause for ingrown toenails, but numerous factors that can encourage their development. The first of these is an improper nail cutting technique. Nails should be cut in a straight, clean line with no fraying or split edges, and no curving or ‘rounding’ the edges of the nail down the sides.

Another common culprit is pulling or picking at the nails. Pulling the top of the nail off instead of cutting them in a straight line with a tool can leave a spicule at the edge of the nail where it is ripped off. Often, this spicule is deep down the side of the nail where it is not visible or felt - until it starts growing and pierces the skin.

Tight footwear is another common cause as it creates pressure on the sides of the toes that can push the nail into the surrounding skin. The shape of the nail can also play a role, especially where the nail is particularly involuted or curved. The shape of the nail, unless acquired from injury, is often linked to uncontrollable genetic factors that dictate the features and shape of the nail.

Ingrown toenails can be managed as a one-off treatment, or can be corrected permanently. For a one-off treatment for first-time ingrown toenails, your Podiatrist will remove the offending nail edge or spicule using specialised nail tools. Removing the nail spicule means that the pierced skin is able to heal and the inflammation, and hence pain, will be able to settle.

If you have a history of developing ingrown toenails then you may wish to permanently correct the problem. The procedure for the permanent correction is called a Partial Nail Avulsion (PNA). It involves removing a small section of the offending nail edge and applying a chemical (often ‘phenol’) to destroy the nail growing cells. The result is a clean, straight nail edge that is only marginally shorter than your standard nail and is often barely noticeable after it has healed. You will be able to discuss the best treatment options and outcomes with your Podiatrist.