An ingrown toenail occurs when the edge of the nail grows into the surrounding periungual skin. It most commonly affects the hallux (big toe). This condition can lead to pain, redness, swelling and infection if not treated promptly.

Ingrown toenails are most often caused by improper trimming of the nails. They can also develop due to trauma such as stubbing a toe or getting it stepped on, and due to poorly fitting shoes.

Pain

An ingrown toenail is when a nail curves down and digs into the skin on the sides of the nail, usually at the corners. This irritates the skin and causes pain, redness, swelling and warmth. This irritated area can progress to infection, marked by drainage and a foul smell. This condition can affect any toenail but it is most common in the big toes and can happen at any age. It becomes more common with age because the toenails get thicker. It can also be caused by some medicines, and it may be hereditary.

Treatment at home can help relieve symptoms and prevent an infection. Soak the toe in warm, soapy water for 20 minutes 2 times a day. While soaking, gently massage the swollen area of the cuticle (the skin next to the nail). This can help the nail corner grow over the edge of the nail rather than into it. You can use a foot soak kit, or simply fill a tub with warm water and add a little salt. You can also buy a special soak product from your drugstore or grocery store.

If a toenail is painful, red and swollen, or has an infection, you should see your doctor. Your doctor may order an antibiotic or drain the pus from an infected toenail. In severe cases, your health care provider may remove part or all of the toenail.

Swelling

An ingrown toenail causes pain from the sharp corner of the nail digging into the skin. This creates redness, swelling and warmth in the area. The irritated skin can break, which allows bacteria to enter the wound. This can lead to a painful, persistent infection in the toe that is marked by drainage and a foul odor.

If you don’t have a complicating medical condition like diabetes that slows healing or poor circulation that reduces sensation, you can treat an ingrown toenail at home with conservative measures. Your health care provider may soak the affected toe with warm water and a quarter cup of apple cider vinegar (the acetic acid in the vinegar has natural antibacterial properties). After soaking, place a piece of cotton or waxed dental floss under the nail and keep it elevated, replacing it daily. This separates the toenail from the skin and encourages it to grow above the edge of the nail, typically in 2 to 12 weeks.

For severe ingrown toenails or those that don’t respond to home treatment, your doctor can perform minor office surgery. Your doctor will numb your toe before performing the procedure, then lift the toenail along its edge that is cutting into the skin. He or she will cut and remove that piece of the nail, which should stop it from growing into the skin again.

Redness

Ingrown toenails may develop redness near the irritated edge of the nail. This is a natural inflammatory response of the body to heal the area. If there is pus around or under the nail, the infection is advanced and needs medical attention. Untreated infections of the toes can lead to serious bacterial involvement extending into the bones, skin and other tissues.

Most cases of ingrown toenails can be treated at home with simple soaking techniques and proper nail trimming. However, patients with diabetes or other foot conditions like nerve problems in the feet or poor circulation need to be seen by a foot and ankle surgeon immediately for evaluation.

Soak the affected toe in warm water containing Epsom salt 3 to 4 times per day for 10 to 20 minutes. After soaking, gently lift the nail edge and place a small piece of cotton or waxed dental floss between the nail and the skin. Change the cotton or floss every day. This will encourage the nail to grow above the skin fold.

For recurrent ingrown toenails, a minimally invasive treatment called Onyfix can provide immediate pain relief and permanent improvement of the nail. This revolutionary nail correction system guides the nails back to their natural shape through a gentle process that is completely painless and requires no removal of the nail or cuticle.

Infection

An ingrown toenail occurs when a nail’s edge digs into the skin and soft tissue next to it. This often causes pain, redness, swelling and warmth in the toe. If bacteria enter the area, the symptoms can become more serious and may include drainage of liquid or pus from the toe, a foul odor and a deep, throbbing pain.

A doctor can diagnose an ingrown toenail by looking at the nail and toe and asking about your symptoms. Tests and X-rays are rarely needed.

Ingrown toenails can be prevented by trimming your nails straight across and making sure they’re long enough for your shoes. You can also help prevent ingrown toenails by wearing shoes that fit well and not squeezing or poking at your toes when you’re trying on shoes.

Ingrown toenails can happen to anyone, but they’re more likely to occur in people with poor circulation in their feet and toes, or those who have diabetes or nerve problems in their feet. The condition can also run in families. Heredity and injury — such as stubbing a toe or getting a splinter under the nail — can also contribute to an ingrown toenail.