An ingrown toenail starts as a red, swollen area along one or both sides of the nail where the edge has pressed into or grown into the surrounding skin. In the earliest stage, the skin next to the nail looks puffy and feels tender when you touch it or put on shoes. As it progresses, you may notice the skin becoming increasingly inflamed, sometimes with visible pus, and in advanced cases, new tissue growing over the nail itself.
Early Stage: Redness and Swelling
The first thing you’ll typically notice is that the skin along one side of the toenail (usually the big toe) looks redder than normal and slightly swollen. The nail fold, that strip of skin hugging the edge of your nail, appears puffy and feels firm or tender to the touch. At this point there’s no drainage or broken skin, just mild inflammation where the nail edge is digging in.
One tricky detail: you may not be able to see the part of the nail causing the problem. The offending edge or corner is often buried beneath the skin fold, so the toe can look mostly normal from above while the pain and redness sit along the side. Pressing gently on the swollen area or squeezing the toe will usually reproduce a sharp, localized pain right where the nail meets the skin.
Moderate Stage: Drainage and New Tissue
If the nail continues pressing into the skin, your body mounts a stronger inflammatory response. The redness deepens, the swelling increases, and you may start to see clear fluid or yellowish pus weeping from the nail fold. The skin around the nail can feel warm or even hot to the touch.
This is also the stage where a granuloma often appears. A granuloma is a small mound of raw, bumpy tissue that forms at the edge of the nail where it’s embedded. The surface looks granular, almost like tiny beads of flesh, and it bleeds easily if bumped. It’s your body’s attempt to wall off the irritation, but it makes the toe look significantly worse, with a fleshy lump sitting right next to or slightly over the nail edge.
Advanced Stage: Tissue Growing Over the Nail
In the most severe cases, the inflammation becomes chronic. The granulation tissue keeps expanding until it starts to grow over the nail itself, partially covering it. At this point the toe is constantly oozing pus, the surrounding skin is deeply reddened or darkened, and the area may have a foul smell. The nail fold is so swollen that it’s hard to tell where the skin ends and the nail begins. Walking is usually very painful, and the toe may bleed with minimal contact.
How It Differs From Other Nail Problems
An ingrown toenail is easy to confuse with a couple of other conditions, especially if you’re just looking at your toe and trying to figure out what’s going on.
A fungal nail infection can also make a toenail look abnormal, but the visual clues are different. Fungal nails become thick, discolored (yellow, white, or brownish), and crumbly along the edge. The surrounding skin isn’t usually red or swollen in the same localized way. With an ingrown nail, the nail itself often looks normal in color and texture. The problem is where it meets the skin, not the nail surface.
An involuted toenail is another common lookalike. This is a nail that curves excessively, with a raised middle and edges that pinch the skin on both sides. It can cause discomfort and sometimes leads to an ingrown nail, but on its own it doesn’t produce the redness, swelling, and pus of a true ingrown. The key difference: an involuted nail is a shape problem you can usually see from above (the nail looks like a half-tube curving downward at the sides), while an ingrown nail is an embedding problem that often hides beneath the skin fold.
Signs That Point to Infection
Not every ingrown toenail is infected. Redness and mild swelling alone are signs of irritation, not necessarily infection. The signs that suggest infection has set in are more specific:
- Pus or liquid drainage coming from the nail fold, especially if it’s yellow or greenish
- Increasing redness that spreads beyond the immediate nail edge into the surrounding toe
- Warmth that you can feel when you touch the toe, noticeably hotter than the other toes
- Darkening of the skin around the nail, which can appear in deeper skin tones instead of the classic redness
- Throbbing pain that persists even when you’re not putting pressure on the toe
On lighter skin, infection shows up as bright redness. On darker skin, the color change can be subtler, appearing as a deeper brown or purplish tone rather than red. Swelling, warmth, and drainage are more reliable indicators across all skin tones.
Why It Matters More for Some People
For most people, an ingrown toenail is painful and annoying but manageable. For people with diabetes, especially those with reduced sensation in their feet, the situation is more serious. Nerve damage can mask the pain that would normally alert you to a problem, so an ingrown nail can progress to infection without the usual warning signals. If you have diabetes, checking your feet daily for changes like redness, swelling, or skin breaks around the nails is a practical habit that catches problems before they escalate. Having a foot specialist trim your nails is also a straightforward way to reduce the risk if your nails tend to curve into the skin.
What a Healing Ingrown Toenail Looks Like
If you’ve been soaking your toe or had a procedure to remove the embedded nail edge, improvement is visible within a few days. The redness fades from deep red or purple to pink, the puffiness in the nail fold goes down, and any drainage stops. A granuloma, if one formed, will shrink gradually over one to two weeks as the irritation resolves. The skin along the nail edge should eventually look flat and smooth again, matching the rest of the toe. If the redness is spreading rather than shrinking, or if pus returns after initially clearing, that’s a sign the embedded nail edge is still there or infection is worsening.