An ingrown toenail (onychocryptosis) is a common and painful condition where the edge of a toenail grows into the soft flesh of the toe. This causes inflammation, redness, and swelling. If left unaddressed, the area may become infected, leading to increased pain and difficulty walking. Knowing which medical professional to consult first can shorten the time to recovery and prevent complications.
Initial Consultation: Primary Care Providers
For many people, the first step in addressing a painful toe is a visit to their primary care provider (PCP), such as a family doctor. These general practitioners manage mild to moderate cases where inflammation is present but infection is minimal or absent. A PCP often advises simple conservative treatments, including regular warm water soaks to reduce swelling and instruction on proper nail care techniques.
They may gently lift the offending nail edge and insert a small piece of cotton or dental floss beneath it to encourage the nail to grow over the skin. If a local infection is evident, characterized by pus or increased warmth, the PCP can prescribe oral antibiotics. If the ingrown nail is persistent, severely infected, or recurs frequently, the PCP provides an informed referral to a specialist.
The Specialist Answer: Podiatry
The definitive expert for the diagnosis and treatment of ingrown toenails is a Podiatrist (Doctor of Podiatric Medicine or DPM). These specialists manage chronic or severe cases that have failed conservative care. Podiatrists routinely perform minor surgical procedures in their office setting, providing a long-term solution with minimal downtime.
The most common procedure is a partial nail avulsion, or wedge resection. The podiatrist numbs the toe with a local anesthetic and removes only the small portion of the nail digging into the flesh. For recurrent ingrown nails, the podiatrist can perform a permanent correction known as a chemical matrixectomy. This technique involves applying a chemical agent, typically phenol, to the nail matrix—the tissue where the nail grows from—to permanently prevent that section of the nail from growing back.
Urgent Situations: When to Go to the ER
Most ingrown toenails do not require emergency care, but certain severe symptoms necessitate immediate attention at an Emergency Room or Urgent Care facility. A key sign of a spreading infection is the presence of red streaks (lymphangitis) extending from the toe up the foot or leg. A fever accompanying the toe pain also indicates the infection is moving beyond the local area and requires urgent medical intervention.
Patients unable to bear weight on the affected foot due to intense, throbbing pain should seek prompt evaluation. Furthermore, individuals with underlying health conditions, such as diabetes, peripheral neuropathy, or poor peripheral circulation, must bypass routine office visits. For these high-risk patients, even a minor foot infection can rapidly progress to a serious complication, such as a bone infection.