Ingrowing toenail treatment: home care, antibiotics and nail surgery

A toenail normally sits in a shallow groove of skin on each side. In an ingrowing toenail the side of the nail, or a sharp spike of it, presses or pierces into that skin. The body treats the nail as a foreign object, so the area becomes inflamed. NHS inform describes the nail as sometimes curling into the toe, with the surrounding skin red, swollen and tender.

The big toe is the usual site, which makes sense because it carries the most pressure in shoes and when you push off to walk. Both sides of the nail can be affected, and some people have the same toe flare up again and again.

The condition is common and rarely dangerous in a healthy adult, but it can be very sore, and an untreated infection can spread. That is why the early home measures and the point at which to seek help are worth knowing.

NHS inform lists several things that may contribute: nails that are not cut well, tight shoes, socks or tights, sweaty feet, an injury to the toe, the shape of the nail itself, and a fungal nail infection. Often more than one factor is present.

Nail shape is the one you cannot easily change. Some people have nails that curve strongly at the edges, and these tend to dig in more readily, particularly in footwear with a narrow toe box.

• Cutting the nail too short, or trimming the corners so a spike regrows into the skin.

• Shoes that squeeze the toes, including pointed or poorly fitting styles.

• Damp feet, which soften the skin and make it easier for the nail to break through.

• A knock, stubbed toe or repeated minor trauma, for example from sport.

• A nail thickened or distorted by fungal infection.

The NHS says a GP will usually suggest a few simple steps first, and these are the same ones advised by NHS inform. Warm, salty water softens the skin around the nail and lowers the chance of infection. NHS Borders gives a practical version of this: two handfuls of salt in a washing-up bowl, with only enough water to cover the toe. Dry the foot properly afterwards.

Footwear matters while the toe settles. Wide, comfortable shoes or open sandals take pressure off the nail edge, and NHS Borders adds that laces or Velcro fastening are better than slip-on styles. Paracetamol or ibuprofen can ease the pain.

The advice on what not to do is just as important. The NHS says not to cut the toenail and to leave it to grow out, not to pick at the toe or nail, and not to wear tight, pointy shoes. Digging out the corner yourself is a common reason a mild problem becomes an infected one.

• A pharmacist can suggest treatments to ease the pain and help prevent infection, and can tell you whether you need a GP.

• NHS Borders suggests self-referring to podiatry if home advice has not settled things after 2 weeks (this is that board's local advice; other areas differ).

The NHS advises seeing a GP if home treatment is not helping, if the toe is painful and swollen with pus coming out, if you have a very high temperature or feel hot, cold or shivery, or if you have diabetes. For someone with diabetes, reduced sensation or circulation in the foot can hide how serious a minor problem has become, which is why the advice is not to wait.

A GP can confirm the diagnosis and prescribe antibiotics if the toe is infected. For a badly ingrown nail, they may refer you to a podiatrist. The NHS notes that NHS podiatry referral may not be available to everyone and waiting times can be long, and that you can pay to see a podiatrist privately. Some areas allow you to refer yourself directly, and the NHS suggests asking reception staff at your practice, checking its website, or contacting your integrated care board to find out.

If the nail keeps growing in, a podiatrist can treat it with a minor procedure. You will usually have an injection of local anaesthetic to numb the toe first. The two options described by NHS Borders are partial and total nail avulsion.

Partial nail avulsion removes only the troublesome edge. NHS Borders describes it as the most commonly used operation for ingrown toenails and says it is about 98% effective. The edges of the nail are cut away and a chemical called phenol is applied to the area to prevent that part of the nail growing back and becoming ingrown in the future. The result is a slightly narrower nail.

Total nail avulsion removes the whole nail. NHS Borders says it may be needed when the nail is thick and pressing into the surrounding skin. You are left with an indentation where the nail was, and the same source states that it is perfectly safe to be without a toenail.

After the procedure the toe is wrapped in a sterile bandage, which helps control bleeding and protects against infection. NHS Borders advises resting the foot and keeping it raised for 1 to 2 days, taking a painkiller such as paracetamol if needed, and wearing soft or open-toed shoes for the first few days.

Your podiatrist will explain how to look after the dressing and when it needs changing, and what to do if the toe becomes more painful, red or starts to discharge. Follow the advice you are given, because it depends on the technique used.

Once the toe has healed, the preventive habits matter again, since a different part of the nail can still become a problem if the same risk factors are present.

The NHS and NHS inform give consistent advice. Cut toenails straight across the top rather than curving into the edges, and avoid cutting them very short. Choose shoes that fit properly and are not too tight. Keep the feet clean and dry them thoroughly after washing.

If a fungal nail infection is part of the picture, treating that may help, and there is more on this in our fungal nail infection guide. People with diabetes should keep to their routine foot checks.