Ingrown Toenail
The edge of a nail, usually the big toe, digs into the skin beside it, causing pain, redness and swelling, and sometimes infection. Common in teens and young adults. Mild ones settle with home care; repeat ones are fixed with minor surgery.
Why it happens. Cutting nails too short or rounding the corners, tight or pointed shoes, sweaty feet, curved nails that run in families, and stubbing or kicking injuries. Swollen, red skin beside the nail with pus is paronychia on top. On brown and black skin, redness can look purple or darker, so swelling, warmth and pain are better guides.
Diagnosis is by look. No tests are needed unless infection keeps coming back or you have diabetes or poor circulation.
The ingrown toenail ladder
Home care first. If it keeps coming back, a small operation to narrow the nail works far better than repeated antibiotics.
- Step 1 · Self-careSoak, lift and give it roomSoak the foot in warm water for 10–15 minutes once or twice a day, dry well, then gently tuck a wisp of cotton wool or dental floss under the nail corner. Wear open or roomy shoes.
- Works
- Not well tested; mild ones often settle in a week or two, but they’re more likely to return than after surgery
- Cost
- Free
- How long
- 1–2 weeks
- Watch for
- Don’t dig out the corner yourself: it often makes the next spike worse.
Bathroom surgery is how mild becomes moderate.
- Step 2 · Allied healthPodiatrist care (trimming, splints, braces)A podiatrist removes the offending spike and may fit a gutter splint or nail brace to guide the nail out.
- Works
- Helps many mild to moderate cases; surgery is more effective at stopping it coming back
- Cost
- About $70–120 a visit; Medicare rebates for up to 5 allied health visits a year with a GP care plan if eligible
- How long
- One to several visits
- Watch for
- Infection, or pain that’s getting worse: get it looked at.
Specialists in feet. Use them.
- Step 3 · PrescriptionAntibiotics for spreading infectionOnly when redness is spreading up the toe or foot, or you have fever, diabetes or poor circulation.
- Works
- Treat spreading infection, but don’t fix the nail; after nail surgery they didn’t reduce infection or speed healing in trials
- Cost
- Under the $25 PBS co-payment
- How long
- Usually 5–7 days
- Watch for
- Repeated courses for the same toe means the nail needs fixing.
Antibiotics treat the fire, not the arsonist.
- Step 4 · ProcedurePartial nail removal with phenolUnder local anaesthetic, a GP or podiatrist removes the ingrowing strip of nail and applies a chemical (phenol) so that strip doesn’t regrow.
- Works
- Came back in about 1 in 7 with phenol vs about 4 in 10 without it in one trial
- Cost
- GP: bulk-billed to about $100–250 out of pocket; podiatrist: about $300–600
- How long
- One procedure; heals in 2–6 weeks
- Watch for
- Drainage and soreness for a few weeks. Healing is slower with diabetes or poor circulation.
A slightly narrower nail and a much happier toe.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Cutting a V-shape in the middle of the nailAn old myth. Nails don’t grow from the sides inward, so it doesn’t help.
- Over-the-counter “ingrown nail” drops and creamsThey soften skin a little; no good evidence they fix the problem.
- Repeated antibiotic coursesThey clear infection for a while, but the spike stays. Fix the nail instead.
What you can do
- Cut toenails straight across, not too short, and leave the corners visible.
- Wear shoes with room for your toes; save tight or pointy ones for short outings.
- Keep feet clean and dry and change sweaty socks.
- If you have diabetes, check your feet daily and see a podiatrist early.
See your GP if
- It’s not improving after a week of home care
- There’s pus, or redness spreading from the nail
- It keeps coming back
- You have diabetes, poor circulation, numb feet or a weakened immune system (see someone early)
See a doctor the same day for redness spreading up the foot, fever, or a foot that’s cold, pale or turning black, especially with diabetes.
Common questions
Should I cut a V in the nail?
No. It’s a myth and doesn’t change how the nail grows.
Will the nail look strange after surgery?
Slightly narrower, but most people find it hard to notice once healed.
Can I still play sport after nail surgery?
Usually after 1 to 2 weeks, once it’s comfortable. Keep it clean and covered while it heals.
Do I need antibiotics after surgery?
Not routinely. Trials found they didn’t prevent infection or speed healing. Keep it clean and see your doctor if redness spreads.
Helpful resources
- Cochrane: Treatments for ingrowing toenailsPlain-language summary of what the trials show. Free.
Evidence and more information
maladywise.com/ingrown-toenail/