Ingrown Toenails: Causes, Risks, and What a Nurse Can Do
One of the most common — and most preventable — foot concerns we treat
Ingrown toenails are one of the most frequently searched foot concerns, and for good reason: they're common, they can be surprisingly painful, and most people aren't entirely sure what to do about them. Should you try to fix it yourself? Go to a walk-in clinic? See a specialist?
The answer, in most cases, is simpler than people expect: see a foot care nurse. Here's everything you need to know about ingrown toenails — what causes them, when they become a real concern, what we can do, and how to prevent them from coming back.
What Is an Ingrown Toenail?
An ingrown toenail occurs when the edge or corner of a toenail grows into the surrounding skin rather than over it. The most commonly affected nail is the big toe, though any toenail can be involved. As the nail presses into the soft tissue, it causes pain, redness, swelling, and — if left untreated — can break the skin and lead to infection.
Ingrown toenails exist on a spectrum of severity, from mild discomfort at the nail edge to a fully infected, draining wound that requires urgent attention. Where someone falls on that spectrum at any given time depends on how long the nail has been ingrown, the health of the surrounding tissue, and the individual's overall health status.
What Causes Ingrown Toenails?
Ingrown toenails can develop for a number of reasons — and in many cases, multiple contributing factors are at play at the same time:
Improper nail trimming. Cutting nails too short, trimming out the corners, or cutting at an angle can all encourage the nail to grow into the surrounding skin rather than straight across. This is one of the most common causes we see.
Tight or ill-fitting footwear. Shoes or socks that press the toes together or compress the nail bed can redirect nail growth inward over time. Narrow toe boxes are a frequent culprit. This is also why the transition from summer to fall is one of the most common times we see patients develop ingrown toenails — feet have spent months in open sandals with minimal pressure on the toes, and the sudden shift back into closed-toe shoes creates a new source of compression that the nail wasn't previously experiencing. If you're making that seasonal footwear change and notice any new tenderness at the nail edge, don't wait to have it assessed.
Nail shape and genetics. Some people are simply born with nails that curve naturally — particularly at the edges. This inherited shape can make ingrown nails more likely regardless of how carefully the nail is trimmed.
Gel and shellac nail polish. As we discussed in an earlier blog, gel and shellac polish cures the nail in the position it's growing in at that moment. If any inward curvature is present, the hardened polish can reinforce and worsen that trajectory as the nail grows.
Trauma. Stubbing a toe, dropping something on the foot, or repetitive pressure from activity can damage the nail plate or the surrounding tissue, creating conditions for the nail to grow incorrectly.
Fungal nail infections (Onychomycosis). Nails thickened and distorted by Onychomycosis are more likely to press into surrounding tissue as they grow.
When an Ingrown Toenail Becomes a Concern
A mild ingrown toenail — one that's tender but hasn't broken the skin — can often be managed with prompt professional treatment. But there are situations where an ingrown toenail needs to be taken more seriously:
Signs of infection. Increasing pain, redness that is spreading beyond the nail edge, warmth, swelling, and any discharge — clear or otherwise — suggest that bacteria have entered the tissue. Infected ingrown toenails need prompt professional attention.
High-risk health conditions. For patients with diabetes, peripheral neuropathy, poor circulation, or immunocompromising conditions, even a mild ingrown toenail carries elevated risk. Reduced sensation means it may go unnoticed until it's already infected. Reduced circulation means healing is slow and infection can escalate quickly. These patients should never attempt to self-treat.
Recurring ingrown toenails. If the same nail keeps becoming ingrown despite proper care, there may be an underlying structural issue — nail shape, footwear, gait — that needs to be assessed and addressed.
If you have diabetes or any condition that affects sensation or healing in your feet, please do not attempt to manage an ingrown toenail at home. Come in and let us assess it safely.
What We Can Do
When you come in with an ingrown toenail, we begin with a thorough assessment of the nail, the surrounding skin, and your overall foot health. What we can do depends on the severity of the situation and your individual health history — and we'll always explain exactly what we're doing and why.
For mild to moderate ingrown toenails, we can carefully reduce the nail edge that is pressing into the skin, relieve the immediate discomfort, and treat the surrounding tissue. We use professional, sterilized instruments and precise technique — this is not something that should ever be attempted with a pair of household scissors or nail clippers at home.
An important note on antibiotics:
Many patients come to us after visiting their doctor and being prescribed an oral or topical antibiotic for an infected ingrown toenail. While antibiotics can help treat the infection itself, they do not fix the underlying problem. The sharp nail edge that is embedded in the surrounding tissue is still there — and as long as it remains, it will continue to cause irritation, reinfection, and inflammation regardless of any medication being taken.
Antibiotics and professional nail care work together, not in place of each other. If you have been prescribed antibiotics for an ingrown toenail, we strongly recommend coming in to have the nail assessed and the offending edge safely trimmed out. Without addressing the nail itself, the problem will persist — and often worsen — even while on medication.
We'll also address any contributing factors we identify — advising on nail trimming technique, footwear, and any products or habits that may be making things worse — and build a care plan to reduce the likelihood of recurrence.
For cases involving infection, significant tissue involvement, or nails that are structurally likely to continue recurring, we will advise on whether referral to a chiropodist or physician for further intervention is the appropriate next step. Our role is to be honest about what falls within our scope and what doesn't — and to make sure you're directed to the right care.
What Not to Do at Home
We understand the impulse to deal with an ingrown toenail yourself — they're uncomfortable and the instinct to fix it immediately is strong. But there are some approaches that consistently make things worse, and we want to be direct about them:
Do not cut a "V" notch in the centre of the nail — this is a common myth and has no effect on how the nail edges grow
Do not dig at the nail edge with a sharp tool — this creates open wounds and significantly increases infection risk
Do not attempt to pack cotton under the nail edge yourself without professional guidance — done incorrectly, this can cause additional trauma
Do not ignore a worsening ingrown nail in the hope it will resolve on its own — it rarely does, and it typically becomes more painful and more complicated over time
Do not apply over-the-counter ingrown nail treatments if you have diabetes or compromised circulation — these products can cause skin damage in high-risk patients
Preventing Ingrown Toenails
The good news is that ingrown toenails are largely preventable with the right habits — and we'll reinforce these at every appointment:
Trim nails straight across (in most cases). Cut nails in a straight line rather than rounding the corners. Leave them long enough that the edge of the nail extends slightly beyond the skin at the sides. There are some cases where nails do need to be rounded, but we use a specific file to prevent any sharp edges from ingrowing.
Don't cut nails too short. Cutting nails too close to the skin removes the edge that protects the surrounding tissue and can encourage the skin to grow over the nail as it regrows.
Choose footwear with an adequate toe box. Shoes that allow your toes to sit naturally without being compressed significantly reduce the risk of nail redirection over time.
Reconsider gel and shellac polish. If you're prone to ingrown nails, hardening the nail in its current position with shellac is worth reconsidering. See our earlier blog for a full discussion of this topic.
See your foot care nurse regularly. Regular professional nail care is the single most effective way to keep nails trimmed correctly and catch any early signs of ingrown development before they become painful.
Don't Let an Ingrown Nail Wait.
Ingrown toenails are one of those concerns that get worse the longer they're left — and one of the most straightforward things we treat. Whether yours is mild or has been building for a while, we can help — comfortably, safely, and without judgment.
Book your appointment at www.solerenewalfootcare.ca. Let's take care of it.
— Natalie Doucet, RPN | Sole Renewal Footcare & Wellness | Oshawa, Ontario
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