Home / Conditions / Ingrown toenail
An ingrown toenail — often shortened to IGTN — is the edge of a nail growing into the skin beside it, most often on the big toe. Caught early it usually settles with care. One that keeps coming back needs that edge dealt with at the root.
Ingrown toenail pain comes in three stages, and they need different things. Most people who see a doctor are at the second or third; many at the first can settle it themselves.
| Sore edge early | Infected red and swollen | Keeps coming back recurrent | |
|---|---|---|---|
| What you see | The nail edge pressing into the skin, slightly red | Red, swollen skin at the edge, sometimes with pus | A red, fleshy overgrowth beside the nail, or the same toe again and again |
| What it feels like | Sore when pressed, or in tight shoes | Throbbing and tender | Sore on and off despite careful nail care |
| What usually helps | Warm soaks, gently lifting the edge, roomier shoes | Cleaning, sometimes a course of treatment for the infection, sometimes draining it | Removing the ingrown edge and treating its root |
| Needs a doctor? | Often not | Yes | Yes — this is when nail surgery helps |
If you have diabetes, poor circulation or numb feet, do not wait with an infected toe. Infections in the foot heal less well and can spread quietly when sensation is reduced. And redness spreading up the foot, or a fever, needs seeing the same day for anyone. Call the clinic and come in.
A toenail grows forward from a root hidden under the skin at its base. Along each side it sits in a fold of skin. When the edge of the nail presses into that fold — because it was cut short into the corner, or squeezed by a shoe, or simply curves that way — the skin breaks, becomes sore, and can become infected.
What a picture cannot show is why the same toe keeps coming back. Cutting the ingrown piece away helps for a while, but the root at that edge is untouched, so it grows the same edge back in the same place.
That is why lasting treatment works at the root. Stop the root at the troublesome edge from growing, and that strip of nail does not return — the nail ends up a little narrower, and the problem stops.
Most IGTN treatment happens without surgery. Nail surgery is for an infected toe that needs help, or one that keeps coming back, and it is a small procedure done under local anaesthetic.
Soak the toe in warm water, then gently lift the corner of the nail; a small wisp of cotton under the edge can keep it lifted while it grows. Wear roomier shoes, and cut the nail straight across rather than into the corners. For a mild ingrown toenail this is often all it takes.
An infected toe needs proper cleaning and dressing, and sometimes treatment for the infection or a small procedure to let it drain. Settling the infection often comes first, before anything is done to the nail itself.
Under a local anaesthetic injection at the base of the toe, the narrow strip of nail that has grown in is removed along its full length. The rest of the nail is left in place. It is a short procedure, and you walk out afterwards.
For a toenail that keeps recurring, the root of that edge is treated at the same time so the strip does not regrow. The nail is slightly narrower afterwards and the problem does not return. Keep the foot raised for a day or two, wear open or roomy shoes, and it heals over a few weeks.
Ingrown toenails here are seen by Dr Palanisamy Arul Murugan, an orthopaedic surgeon whose areas include foot and ankle, and who sees both adults and children. He holds the MRCS (Edinburgh), MMed (Orthopaedics) and FRCS (Orthopaedics), has practised in Singapore since 2010, and consults in English, and in Tamil or Hindi if preferred.
Often, if it is early and not infected. Warm soaks, gently lifting the corner, roomier shoes and cutting the nail straight across help most mild cases. If it becomes red, swollen or weeping, or you have diabetes, have it seen rather than dealing with it at home.
No. It is a common piece of advice, but it does not change how the edge grows and can make the nail harder to manage. Cutting straight across is what helps.
It depends on what is done. If only the ingrown edge is removed, that edge grows back. If the root of that edge is treated as well, the strip does not return and the nail stays slightly narrower — which is the point, for a toenail that keeps coming back.
The toe is numbed with a local anaesthetic injection first, which is the uncomfortable part. After that the procedure itself should not hurt. It can be sore for a few days afterwards.
Start with how the nails are cut and the shoes worn, since those drive most teenage cases. If the same toe keeps coming back, treating the root of that edge usually ends it, and it can be done for children as well as adults.
No. Just book, and let us know if you have diabetes or problems with circulation, as that changes how quickly the toe should be seen.
Tell us if you have diabetes or problems with circulation when you book. It changes how quickly an infected toe should be seen.
