What Causes an Ingrown Toenail?
An ingrown toenail occurs when the edge or corner of the nail presses into or grows into the surrounding skin. It most commonly affects the big toe, although it can develop on other toes as well. Cutting the sides of the nail too deeply, rounding off the corners, or trimming the nail too short can cause the growing nail to push into the surrounding skin. Leaving a sharp corner on the edge of the nail may also damage the skin as pressure is applied while walking. For this reason, the way toenails are trimmed plays an important role in the development of an ingrown toenail. However, incorrect nail trimming is not the only cause. The natural shape of the nail, the structure of the toe and a person’s daily habits can also contribute to the condition.
Tight-fitting footwear, repeated trauma, intensive sporting activities and prolonged pressure on the toes can all increase the likelihood of developing an ingrown toenail. Activities such as football, running, ballet and long-distance walking, where the toes repeatedly press against the front of the shoe, may increase the risk. Some people naturally have thicker, wider or more curved nails, which can place greater pressure on the surrounding skin. Excessive sweating can soften the skin around the nail, making it easier for the nail to penetrate the tissue. Nail injuries, abnormal nail growth, thickened nails and poorly fitting socks that create additional pressure may also contribute to the development of an ingrown toenail.
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How Can You Tell if You Have an Ingrown Toenail?
The first signs of an ingrown toenail usually include tenderness, pain and mild redness along one side of the nail. In the early stages, discomfort may only be noticeable when wearing shoes, walking or touching the affected area. Mild swelling and warmth may also develop where the nail meets the skin. As the condition progresses, the pain can continue even while resting and may make it uncomfortable to wear shoes or walk normally. Swelling of the skin around the nail, the edge of the nail becoming less visible or the corner of the nail appearing buried beneath the skin are all common indications of an ingrown toenail.
If an infection develops, the redness and swelling often become more pronounced. Fluid discharge, unpleasant odour, yellow or white pus, bleeding and raised tissue that is easily irritated may appear around the nail. This raised tissue may represent granulation tissue, which develops as a result of prolonged irritation. If redness spreads further along the toe, the pain rapidly worsens, the toe becomes noticeably warmer or symptoms such as fever and chills occur, the possibility of infection should be assessed. People with diabetes, poor circulation, nerve damage or conditions affecting the immune system should pay particular attention even to minor symptoms. As pain may be reduced and wounds may heal more slowly in these individuals, any changes around the nail should be assessed by a healthcare professional.
Can Tight and Pointed Shoes Trigger an Ingrown Toenail?
Tight and pointed shoes can squeeze the toes together, increasing the pressure placed on the skin surrounding the toenails. When there is insufficient room in the toe box, the big toe is continuously pressed against the inside of the shoe. This pressure can force the edge of the nail into the surrounding skin or encourage the skin to grow over the nail. If the nail has been cut incorrectly, naturally curves inward or has a sharp edge, wearing tight footwear may cause symptoms to develop more quickly. Although tight shoes are not the sole cause of an ingrown toenail, they are recognised as an important contributing factor and can make an existing problem significantly worse.
High-heeled shoes can also increase pressure on the front of the foot by shifting body weight forwards, causing the toes to become even more compressed. Wearing tight, rigid or pointed footwear for long periods places constant pressure on the delicate tissues surrounding the nail. If your toes cannot move comfortably inside your shoes, the toe box may be too narrow. When choosing footwear, it is important to consider not only the shoe size but also the fit, width and the amount of space available for the toes. Sports shoes should provide adequate support while allowing the toes to move naturally. Feet that slide forwards inside the shoe can also cause the toenails to repeatedly strike the front of the footwear, making the correct shoe length and secure fastening equally important.
What Problems Can Occur if an Ingrown Toenail Is Left Untreated?
If left untreated or repeatedly irritated, an ingrown toenail can progress from mild tenderness to severe pain and significant inflammation. As the nail continues to damage the surrounding skin, the protective barrier is broken, making it easier for bacteria to enter the area. This can lead to an infection around the nail, causing redness, swelling, warmth, discharge and throbbing pain. Persistent irritation may also result in the development of red, raised tissue that bleeds easily along the edge of the nail. As swelling and infection increase, wearing shoes, walking, exercising or standing for extended periods can become increasingly difficult. To avoid pain, some people unconsciously change the way they walk, which may eventually lead to discomfort in other parts of the foot.
If the infection spreads into the surrounding skin and soft tissues, more comprehensive medical assessment and treatment may be required. In rare cases, particularly when an infection has been neglected for a prolonged period or when the individual has underlying circulatory or immune system conditions, the infection may spread into deeper tissues. People with diabetes, peripheral vascular disease, reduced sensation in the feet or a weakened immune system are at greater risk of complications. For this reason, symptoms such as pus, rapidly spreading redness, increasing swelling, severe pain, fever, chills or a wound that fails to heal should not be ignored or managed solely at home. In people who experience recurrent ingrown toenails, simply cutting away the visible corner of the nail may provide temporary relief but is unlikely to address the underlying nail shape or the source of pressure causing the problem.
What Can Be Done to Prevent an Ingrown Toenail?
One of the most effective ways to prevent an ingrown toenail is to trim the nails correctly. Toenails should be cut straight across without removing the corners too deeply or trimming them excessively short. Rounding off the corners can encourage the nail edge to grow into the surrounding skin as it grows. If any sharp edges remain after trimming, they should be gently filed to prevent them from damaging the skin. Nail clippers and files should be kept clean, used only by one person and not shared. If the nails are particularly thick, difficult to trim safely due to limited movement or poor vision, or if the individual has diabetes or circulatory problems, seeking professional foot care may be the safest option.
Footwear should fit both the length and width of the foot properly, providing enough room for the toes to move comfortably. Tight socks, pointed shoes and footwear that places continuous pressure on the toes should be avoided whenever possible. Appropriate footwear should always be worn during sporting activities, and care should be taken to prevent the feet from sliding forwards inside the shoes. Washing the feet regularly, drying carefully between the toes and changing damp socks can all help maintain healthy skin around the nails. The toes should also be checked regularly for redness, tenderness, swelling or changes around the nail. If any of these signs appear, attempting to cut into the nail or remove the affected area with sharp objects should be avoided. Pulling at the nail edge, cutting the surrounding skin or inserting pointed objects beneath the nail can increase the risk of injury and infection.