Ingrown toenail.

About ingrown toenails

An ingrown toenail (onychocryptosis) occurs when the edge of a toenail grows into the surrounding soft tissue rather than over it. The big toe is by far the most commonly affected. The body responds with inflammation, pain, and often infection — producing the characteristic red, swollen, painful, sometimes discharging side of the toe.

Early ingrown toenails may settle with conservative measures. Established or recurrent ingrown toenails usually need definitive surgical treatment to stop the problem permanently.

Common causes

• Cutting nails too short or curved — the corner of the nail grows into the surrounding skin rather than out
• Tight footwear — particularly narrow toe boxes that push tissue against the nail edge
• Genetic nail shape — some people have naturally curved nails that are more prone to ingrowing
• Trauma — stubbing the toe, dropping things on it, repetitive impact (running, football)
• Excessive sweating — softens the skin and makes it more susceptible
• Poor pedicure technique — including cutting too aggressively into the nail corner
• Hyperhidrosis or fungal infection of the nail/skin
• Adolescence — peak incidence; foot growth and shoe size mismatches

Severity stages

Stage 1 (Mild)

Redness, swelling, and pain along the nail edge. No discharge. The nail edge is starting to dig in but the skin remains intact. Often responds to home care.

Stage 2 (Moderate)

Established inflammation with pus discharge, more pain. The skin alongside the nail may be raised and inflamed. Often needs antibiotic treatment alongside care — but home treatment alone rarely cures it. Many proceed to definitive surgery.

Stage 3 (Severe / chronic)

Significant tissue overgrowth (granulation tissue) around the nail edge, often with chronic discharge. Permanent skin changes. Definitive surgery is the standard treatment — conservative measures rarely succeed at this stage.

Early home care

For early (stage 1) ingrown toenails or while waiting for treatment, home measures can help:

• Soak the foot in warm soapy water 2–3 times daily for 10–15 minutes
• Gently dry, particularly around the nail edge
• Wear open-toed or loose shoes
• Avoid trimming the affected corner aggressively
• Place a small piece of clean cotton under the nail edge to lift it away from the skin (only if comfortable)
• Take paracetamol or ibuprofen for pain
• Keep the foot elevated when resting

If symptoms don’t improve in 5–7 days, or worsen, seek treatment.

How the procedure works

Partial nail avulsion with phenolisation is the standard definitive treatment. The procedure:

1. Examination — confirming the diagnosis and which nail edge is affected.
2. Local anaesthetic — a digital ring block anaesthetises the entire toe. Two small injections at the base of the toe. The injection stings briefly; afterwards the toe is numb for hours.
3. Cleaning — the area is cleaned with antiseptic.
4. Removal of the offending nail edge — a strip of nail (typically the lateral 4–8mm) is gently separated from the nail bed and removed entirely back to its growing root (matrix). The rest of the nail remains intact.
5. Phenolisation — phenol (a chemical) is applied to the exposed nail matrix to destroy the part that grew the offending edge. This prevents that strip of nail from ever regrowing.
6. Dressing — a sterile dressing is applied. No stitches needed.

Total time: 30–45 minutes including anaesthetic time. Both sides of the same toe can be done at once if needed; sometimes the whole nail is removed if the entire nail is the problem.

About phenolisation

Phenol (carbolic acid) was first used for this purpose in the 1940s and remains the standard. It works by destroying the cells in the nail matrix that produce the nail edge — effectively a chemical “sterilisation” of that portion of nail-forming tissue.

Benefits over simple removal (without phenol):

• Recurrence rates around 5% with phenolisation vs 25–50% without
• No need for excisional surgery of the matrix (more invasive)
• Quick to apply
• Well tolerated

The result: a nail that looks normal but is permanently narrower on the affected side. Most patients find this cosmetically acceptable and worth the trade-off for permanent cure.

After the procedure

You walk out the same day, with the anaesthetic still working for several hours. General after-care:

• Keep the foot elevated for the first 24 hours where possible
• Take simple painkillers (paracetamol/ibuprofen) as the anaesthetic wears off
• Keep the dressing dry for 24 hours
• From day 2, soak the toe in warm salty water once or twice daily and re-dress
• Wear open or loose shoes for at least 1–2 weeks
• Avoid running, football, or other strenuous activity for 1–2 weeks
• Some clear or slightly bloody discharge is normal for 1–2 weeks — the nail bed is healing
• Pain is usually modest after the first 24 hours; severe pain warrants review
• The healing is typically complete by 4–6 weeks

Preventing recurrence and new ingrown nails

For nails not yet ingrown, or for the other toes:

• Cut nails straight across — not curved into the corners
• Leave a small visible white tip — don’t cut too short
• Use proper nail clippers — not scissors which encourage curving
• Wear well-fitting shoes — particularly during sport
• Address fungal nail infections if present
• Manage sweating with cotton socks, daily washing
• Don’t pick at the corners of nails

When to see us

Book a consultation if:

• You’ve had repeated ingrown toenail episodes on the same toe
• You have a current ingrown toenail not settling with home care
• You have an infected ingrown toenail (pus, swelling, redness)
• You’ve had previous removal that didn’t solve the problem
• You have diabetes and any toenail problem
• You’d like preventive treatment because you’re prone to ingrowing nails

Frequently asked questions

Does the injection hurt?

The injection of local anaesthetic into the base of the toe stings briefly — it’s the worst part of the procedure for most people. We use small needles and slow injection technique to minimise this. Once the anaesthetic is in, the toe is completely numb and the rest of the procedure isn’t painful.

How long until I can walk normally / return to sport?

Walking normally usually within 24–48 hours. Light sport (jogging) often within 1 week. Heavier impact sport (football, running, basketball) usually 2–3 weeks once healing is complete.

How much does it cost?

Current prices are on our Fees page. The procedure cost includes consultation, anaesthetic, materials, and follow-up review.

Will the nail look normal afterwards?

The nail will be slightly narrower on the treated side. Most people find this cosmetically acceptable — barely noticeable in most cases. Complete cosmetic restoration isn’t possible without risking recurrence.

Will my insurance cover this?

Most UK PMI policies cover ingrown toenail surgery as a recognised procedure. We provide procedure codes. Check directly with your insurer.

What if I have diabetes?

Diabetes increases the risk of foot complications. We assess diabetic patients carefully, may liaise with your diabetes team, and may recommend the procedure be done under specific protocols. Don’t leave diabetic foot infections untreated.

Can I drive home?

The toe is numb but you can usually drive. Bring loose shoes/sandals. Some patients prefer to have someone drive them; this is reasonable.

Is there a non-surgical option?

For mild (stage 1) cases, conservative measures sometimes work. For established cases, conservative treatment generally fails and the toe remains painful and prone to infection. We’ll discuss what fits your specific stage.

What if it comes back?

~5% of phenolisations recur. If it does, we can re-treat or refer to plastic surgery for more extensive nail matrix surgery if needed.

Can children have this done?

Yes — children with significant or recurrent ingrown toenails can have the procedure, typically from age 10 or so if they’ll tolerate the injection. Younger children may need general anaesthetic and are referred to paediatric surgery.