The Ingrown Toenail...It's Treatment 101

ingrown toenail treatment

The have an ingrown toenail- maybe like the one in the picture. It is sore, you are desperate. So what can you do?

Treatment for Ingrown Toenails depends upon 2 things.

1. Where the problem is and,

2. How long they have had the problem for.

For a problem like this I would go and see a Podiatrist/ Chiropodist.

Many home treatments fail to do anything and can even make the problem much worse.

I am active in the Yahoo Answers Community. Here is someone who posted a question and did search online for help:


Swollen big toe-ingrown/hang nail? So last week sometime i clipped a piece of flesh/nail from the corner my big toe (right foot if it matters). i noticed a little stinging for a few days but it wasn't until yesterday that it actually began to swell and turn dark around the cuticle. I goggle and self diagnosed a ingrown /hangnail, so i did the epsom salt soak then doused with peroxide and applied some triple antibiotic ointment. My problem now is that since i've done all that this evening, its actually gotten a bit more painful and swollen a little more. there is no pus draining its just the pain and discoloration. should i continue the epsom salt until at least weekend or just suck it up and go to the doctor now?


You have to be very careful with home treatments

The problem comes in the fact that peroxide, epsom salts and ointments are going to do more damage. They will make the area very wet and make the nail dig in further and get infection to go into moist tissue.

For the majority of patients, conservative treatment methods for ingrown toenails are needed from a clinic. If the problem occurs from the tip to quarter of the way down the side of the nail, then small nippers should easily remove the offending nail with minimal discomfort to the patient. The clinician would then use a Blacks file to smooth the edge of any rough edges. It is a relatively painless 5 minute procedure.

If you have had one ingrown toenail, and that is the one you are treating, then Nail Surgery is not really advised, mainly because it is overkill- there is no need, unless the nail is too bad to work on conservatively. Usually the toe, once the spike has been taken out, will reduce itself to its original size and the inflammatory reaction will reduce. Just like taking a splinter out of your skin, once it has been done, the site heals itself up without problem.

 5 questionable home treatments

There are no home treatments that can effectively take out ingrown toenails without making the problem worse:

1. Use salt water. Only use it for 3 mins max and then dress the area with a clean dressing that covers the whole area. Salt water bathe daily and change the dressing at the same time. This will keep down infection until you get to see someone. If you need to have a shower/ bath then keep your dressing on when you do bathe, but do the redressing routine when you come out.

2. Cutting the nail yourself- it is difficult to see the nail and you can cut skin which makes things worse. Always place a sterile dressing over the affected area- never put tape on the area because it will stick and cause pain. Change this daily.

3. Does cutting a “V” shaped section out of the nail help? No. There is nothing to suggest, or even proven that it eases pressure, all it will do is cause holes in hosiery and socks.

4. Some people favor inserting cotton wool down the sides of the sulci to relieve the pressure and some people have noted success with this type of treatment. I have reservations about sticking anything foreign down the sulci. I believe that people forget about the cotton wool and now you have debris that will not degrade and will become compact over time causing extra pressure and problems. I believe that this is a poor treatment option that has been around for a long time so it seems like it is “standard treatment practice”.

5. Another treatment option is the application of a brace to the nail that lifts up the sides of the ingrown toenail. This is a similar technique to the cotton wool idea, but the brace is attached over the nail and can be checked and removed after a month of wearing the brace. Many people have reported success, but again I have doubts about the long term use of such a device. A brace adds more pressure to the skin especially when they are solid objects so choice of patient needs to be considered. The use of the brace means that the patient needs to revisit in one month of application to see if there is any difference.

Unfortunately adherence is a problem and it is likely that the brace will be tampered with especially if it is left on for long periods of time. Also it is a nail growth problem, once the brace has been removed is the nail going to be ingrown free? Probably not.

More severe ingrown toenails- or Plan B

This is where it gets slightly gray.

The best, simplest and easiest treatment for severe or reoccurring ingrown toenails is the use of minor surgery. Now many clinicians have different methods and different ways of doing this simple procedure, unfortunately they can mess it up for everybody as well.

What we do is the following:

1. Assess the patient, making sure that they know what is happening, they want it done and other treatment options have been discussed.

2. Inject the toe with local anesthetic, this does sting a bit but then the whole toe goes numb. You will be able to feel tugging but no pain, in done right.

3. We test the toe- make sure you can not feel anything, if you can we might wait longer (takes 10 mins to kick in) or give you more- into an area where you can't feel.

4. We then begin, and using specialized nail clippers we clip the offending part of the nail away. If it is for the sides of the nail we take both sides out- forces push over and will cause an ingrown nail on the other side if not done, also it looks better. If removal of the whole nail, we remove the nail.

5. Any removal of the nail comes with it the matrix- where the nail grows from. Any left behind will start the whole process again.

6. We then apply Phenol to the area where the matrix comes from. This stops the nail growing back 97% of the time. In certain circumstances we would not use Phenol as we want the nail to grow back.

7. We dress the area and make sure the patient is OK, and then we see them back the next day and then every week after that, giving instructions on how to take care of the toe.

In all of this the patient has not had their skin cut, can walk in and out of the clinic and the procedure itself took 8 minutes. In all the body takes 4-6 weeks to heal the toe if you are fit and healthy. Its because of the Phenol that it takes so long, but you should walk out pain free ;)

This is mine, the left big toe with a total nail removal. It was a long standing issue hence why the skin looks like that:

total nail removal


One of the main complications is regrowth of the nail. Sometimes it can be a small bit of nail, a larger bit of nail or the removed nail- that comes back.

There is no complete guarantee, there is always a certain percentage of patients that regrowth occurs. In some cases it is anywhere between 5-10%.

Here is mine- this is on the right foot and appeared 5 years or so after the procedure. So the left foot is the picture above- which was done in one clinic. And the below picture was done in a different clinic. Same procedure. Does it hurt? No:

ingrown toenail regrowth

Other procedures

1. If you go to hospital, sometimes they surgically cut the matrix away which increases healing time and many times the nail grows back because they haven't got all of it.

2. There is a procedure (VanBoss) where the skin is cut away by the side of the nail. Looks quite brutal on Youtube but the theory goes that instead of a nail issue, you have a skin issue- too much of it. Remove the skin, cure the toenail. It actually does work, but for a small spike of nail or a completely twisted nail, it is overkill and not the cause- respectively.

All in all it depends upon the site of the ingrown toenails, if there is infection and how long you have had it to decide what needs to be done.

Why have I got an ingrown toenail?

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About Dominic Hough

Hi. I'm Dominic. I treat patients every day at a local clinic. I am a trained Chiropodist and I care about prevention. I designed the website to help readers understand treat and even prevent issues from happening to their feet.