Ingrown Toenail: Causes, Home Care, When Nail Removal Is Needed, and Why Cutting It Yourself Makes It Come Back
An ingrown toenail (Onychocryptosis) is a condition in which the edge of the nail grows into the skin beside it, causing pain, redness and swelling, and sometimes an infection with pus. It is most common on the big toe. It can interfere with walking and often comes back if not managed properly. Many people repeatedly trim away the piercing edge themselves, which usually makes things worse. In this article, a dermatologist explains what causes ingrown toenails, how severity is graded, what you can do at home, when a partial nail removal and nail matrix cautery are needed to prevent recurrence, and the special precautions for people with diabetes.
What causes an ingrown toenail?
An ingrown toenail occurs when the side edge of the nail grows into or presses against the skin beside it, causing injury and inflammation, and sometimes red, raised tissue (granulation). Common factors include:
Incorrect nail trimming, especially cutting too short or rounding the corners, so the regrowing edge pierces the skin.
Tight or narrow-toed shoes that squeeze the toes.
Injury to the nail, such as repeated knocks or stubbing.
Nail shape and genetics, such as a nail that is strongly curved from the start.
Damp feet or heavy sweating, which soften the skin beside the nail and make it easier to pierce.
How many grades of ingrown toenail are there?
Grading helps choose the most suitable treatment.
Grade 1 (early): the nail edge is tender with mild redness and swelling, and there is no pus yet.
Grade 2 (moderate): more pain, clear redness and swelling, with fluid or pus oozing; infection is starting.
Grade 3 (severe/chronic): red, raised tissue grows over the nail edge, with long-standing inflammation and frequent recurrence.
Home care (for mild cases)
Soak the foot in warm water 2 to 3 times a day to reduce swelling and soften the skin.
Lift the nail edge by gently placing cotton or dental floss under the corner of the nail to raise it off the skin (only when there is no infection).
Trim the nail correctly: cut straight across, level with the tip of the toe, and do not cut too short or curve deeply at the corners.
Wear wide-toed shoes to reduce pressure on the toes.
Avoid digging at the nail or cutting the edge deeply yourself.
See a doctor if there is no improvement in 2 to 3 days, or if there is pus, severe pain or repeated episodes.
When is a procedure needed, and why does cutting it yourself make it come back?
Repeatedly trimming away the piercing edge yourself usually helps only temporarily, because the new nail edge grows back and pierces the skin again, and digging deeply risks infection. For moderate to severe cases, or when the problem keeps coming back, the doctor performs a minor procedure with a more lasting result.
Partial nail removal (partial nail avulsion) under local anesthesia, removing only the side edge that is piercing the skin, not the whole nail.
Cautery of the nail matrix on that side (matricectomy) with phenol or electrocautery so that the edge on that side does not regrow and pierce the skin again. This greatly reduces recurrence and is the standard approach for recurrent ingrown toenails.
Antibiotics and removal of the red, raised tissue when infection is also present.
A tissue biopsy when the tissue beside the nail looks abnormal, grows quickly or does not heal for a long time, to rule out certain growths.
After the procedure, the wound usually heals in 2 to 4 weeks, and the chance of recurrence is low when the nail matrix is also cauterized.
Special precautions for people with diabetes and poor circulation
People with diabetes, poor blood flow to the feet, or numbness in the feet are at high risk of an ingrown toenail wound progressing into a serious foot infection. This group should not trim or dig at the nail themselves and should see a doctor early so the wound can be monitored closely.
Prevention
Trim nails straight across, level with the tip of the toe, without cutting too short or curving deeply at the corners.
Wear well-fitting, wide-toed shoes that do not squeeze the toes.
Keep feet clean and dry to reduce dampness.
If you often get ingrown toenails, talk to a doctor about planning a permanent procedure.
Frequently asked questions (FAQ)
What causes an ingrown toenail?
An ingrown toenail occurs when the nail edge grows into or presses against the skin beside the nail. It is linked to trimming nails too short or rounded at the corners, tight shoes, injury, nail shape and damp feet.
Can an ingrown toenail heal on its own?
An early, uninfected case may improve with warm soaks, lifting the nail edge and correct trimming. If there is pus, severe pain, red raised tissue or repeated episodes, it usually will not heal on its own and you should see a doctor.
Can I cut out the piercing nail edge myself?
This is not recommended. It helps only temporarily, the new nail edge grows back and pierces the skin again, and digging deeply risks spreading infection. Have a doctor assess it and perform a suitable procedure.
How is an ingrown toenail treated so it does not come back?
For recurrent ingrown toenails, the doctor usually removes the piercing side edge of the nail and then cauterizes the nail matrix on that side with phenol or electrocautery. This greatly reduces recurrence and is the standard approach.
Does ingrown toenail surgery hurt, and how long does it take to heal?
It is done under local anesthesia, so it does not hurt during the procedure. The wound usually heals in 2 to 4 weeks, and you can walk normally if you follow the wound care instructions.
Is an ingrown toenail dangerous if I have diabetes?
It is more dangerous than for others, because foot wounds in people with diabetes are at risk of spreading into serious infection. Do not trim or dig at the nail yourself, and see a doctor early.
Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed August 3, 2026
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