Ingrown toenails: how and why do we get them?
An ingrown toenail is one of the most common foot conditions treated by podiatrists. While it may begin as a minor irritation, an untreated ingrown toenail can become painful, infected, and disruptive to daily activities. Understanding how ingrown toenails develop can help patients recognize symptoms early and seek appropriate treatment before complications occur.
What Is an Ingrown Toenail?
An ingrown toenail occurs when the edge or corner of a toenail grows into the surrounding skin rather than growing straight outward. The condition most commonly affects the big toe, although any toenail can become ingrown. As the nail presses into or penetrates the skin, it triggers inflammation that can cause pain, redness, swelling, and sometimes infection. [apma.org], [foothealthfacts.org]
The Etiology of Ingrown Toenails
From a medical standpoint, ingrown toenails develop because of a mechanical conflict between the nail plate and the surrounding skin. In simple terms, the nail edge continually irritates or penetrates the soft tissue around it. Over time, this repeated pressure leads to inflammation and may create an opening where bacteria can enter and cause infection. [foothealthfacts.org], [familypodi...centre.com]
The most common causes include:
Improper Nail Trimming
Perhaps the leading cause of ingrown toenails is cutting toenails too short or rounding the corners. When the nail grows back, its edge may curve downward and into the adjacent skin. Both the American Podiatric Medical Association (APMA) and Foot Health Facts identify improper trimming as a major contributor. [apma.org], [foothealthfacts.org]
Tight or Ill-Fitting Footwear
Shoes with narrow toe boxes, tight socks, or footwear that crowds the toes can place excessive pressure on the nail and surrounding tissue. This compression encourages the nail to grow into the skin. [mayoclinic.org], [foothealthfacts.org]
Repetitive Trauma
Activities that repeatedly stress the toes—such as running, soccer, dancing, or kicking sports—can increase the likelihood of developing an ingrown toenail. Stubbing a toe or having something dropped on it can also trigger the condition. [apma.org], [foothealthfacts.org]
Hereditary Factors
Some individuals are born with naturally curved nails, thicker nails, or foot anatomy that makes them more prone to ingrown toenails. In these cases, even proper nail care may not fully prevent the problem. [apma.org], [foothealthfacts.org]
Nail and Skin Conditions
Fungal nail infections, nail deformities, and chronic conditions affecting nail growth can contribute to the development of ingrown nails by altering nail shape and thickness. [foothealthfacts.org], [mayoclinic.org]
Risk Factors
Certain individuals face a higher risk of developing ingrown toenails, including:
Teenagers and young adults, whose feet tend to perspire more, softening the skin around the nail. [mayoclinic.org]
Athletes who participate in running, soccer, ballet, and other activities that stress the toes. [mayoclinic.org], [my.clevela...clinic.org]
People who wear tight-fitting shoes regularly. [mayoclinic.org], [foothealthfacts.org]
Individuals with naturally curved or thick toenails. [foothealthfacts.org], [my.clevela...clinic.org]
Patients with diabetes, circulatory disorders, or nerve damage affecting the feet. These conditions increase the risk of complications from even minor foot problems. [apma.org], [foothealthfacts.org], [mayoclinic.org]
Common Presentations and Symptoms
Ingrown toenails often progress through stages. Early recognition is important because treatment tends to be easier and more effective before infection develops.
Early Symptoms
Patients may initially notice:
Tenderness along one side of the toenail
Mild pain when pressure is applied
Redness around the nail border
Localized swelling
Discomfort while wearing shoes or walking [mayoclinic.org], [apma.org], [foothealthfacts.org]
Signs of Infection
If the nail continues to penetrate the skin, bacteria may enter the area and cause infection. Symptoms may include:
Increased redness and swelling
Warmth around the toe
Drainage or pus
Bleeding
Foul odor
Worsening pain and throbbing discomfort [apma.org], [foothealthfacts.org], [my.clevela...clinic.org]
Chronic or Advanced Cases
In longstanding cases, patients may develop excess inflamed tissue, sometimes called "proud flesh" or granulation tissue, along the side of the nail. This tissue can bleed easily and make wearing closed shoes extremely uncomfortable. [apma.org], [my.clevela...clinic.org]
Where Should Patients Turn for Help?
Many mild ingrown toenails can improve with appropriate home care, but professional evaluation is often necessary when symptoms persist or signs of infection develop.
Patients should seek medical attention if they experience:
Persistent pain or swelling
Drainage or pus
Increasing redness
Difficulty walking or wearing shoes
Recurrent ingrown toenails
Symptoms that do not improve with conservative care [apma.org], [foothealthfacts.org], [mayoclinic.org]
Why a Podiatrist Is Often the Best Choice
Podiatrists specialize in conditions affecting the feet and ankles and routinely treat ingrown toenails. Depending on the severity of the condition, a podiatrist may:
Remove the ingrown nail border
Treat associated infection
Recommend preventive nail-care strategies
Perform a minor in-office procedure to prevent recurring ingrown nails from returning [apma.org], [foothealthfacts.org], [mayoclinic.org]
Special Considerations for High-Risk Patients
Individuals with diabetes, poor circulation, peripheral vascular disease, or nerve damage should seek professional care promptly rather than attempting self-treatment. These conditions increase the risk of serious infections and delayed wound healing. [apma.org], [foothealthfacts.org], [mayoclinic.org]
Final Thoughts
Although ingrown toenails are common, they should not be ignored. What starts as mild tenderness can progress to infection, significant pain, and recurring foot problems. Improper nail trimming, tight footwear, trauma, and inherited nail characteristics are among the most common causes. Recognizing symptoms early and consulting a podiatrist when needed can help patients find relief quickly and avoid complications.
Sources
American Podiatric Medical Association (APMA): Ingrown Toenails [apma.org]
Foot Health Facts (American College of Foot and Ankle Surgeons): Ingrown Toenail [foothealthfacts.org]
Mayo Clinic: Ingrown Toenails – Symptoms and Causes [mayoclinic.org]
Cleveland Clinic: Ingrown Toenails – Signs, Causes, Treatment & Prevention