Onychocryptosis, commonly known as an ingrown toenail, is a frequent foot problem occurring when the edge of the nail plate grows into the surrounding skin, typically on the big toe. This abnormal growth pattern causes inflammation, redness, and pain at the nail fold. The appropriate professional who removes or treats the condition depends entirely on the severity of the ingrown nail. Treatment options range from simple conservative measures done at home to minor surgical procedures performed in a clinic setting.
Managing Minor Cases at Home
Mild ingrown toenails without signs of infection can often be managed at home. Conservative treatment focuses on reducing inflammation and guiding the nail away from the soft tissue. A common strategy involves soaking the affected foot in warm water for 10 to 20 minutes several times a day to soften the skin and relieve pressure.
After soaking, gently lift the nail edge and place a small wisp of cotton or waxed dental floss underneath it. This acts as a wedge to separate the nail from the skin, encouraging the nail to grow over the skin rather than into it. Proper nail trimming is also a preventative measure, requiring the nail to be cut straight across without rounding the corners.
Self-treatment is only appropriate for cases without significant inflammation, drainage, or severe pain. Spreading redness, visible pus, or intense, persistent discomfort indicates the issue requires professional medical attention. Attempting “bathroom surgery” by cutting out the nail spicule can worsen the condition and increase the risk of infection.
The Role of Primary Care Physicians
If home remedies fail or if the toe shows signs of a localized infection, consult a primary care provider (GP or family doctor). These physicians manage mild to moderate cases of onychocryptosis. Initial intervention involves a thorough assessment to determine the extent of inflammation and whether an active infection is present.
If the site is infected, the physician may prescribe oral antibiotics. They may also perform minor in-office procedures, such as numbing the toe and gently lifting the nail edge to place a splint or cotton wick underneath it. In some instances, they might partially remove the ingrown section of the nail to provide immediate relief and allow the skin to heal.
Primary care physicians refer patients to a foot specialist when the ingrown toenail is recurrent, severely infected, or associated with significant tissue overgrowth. They handle the initial infectious phase and conservative procedures. This referral ensures that patients with underlying structural issues receive a definitive, long-term solution from a podiatrist.
When to Consult a Podiatrist
A podiatrist (Doctor of Podiatric Medicine, or DPM) specializes in foot and ankle conditions and is the definitive professional for permanent correction of problematic ingrown toenails. They are trained to perform minor surgical procedures in a clinical setting. Consultation is warranted for recurring ingrown nails, deeply embedded edges, or any case that has failed to respond to conservative treatments.
The most common procedure is a Partial Nail Avulsion (PNA), a minimally invasive surgery performed under local anesthesia. During a PNA, the podiatrist removes only the small, problematic portion of the nail digging into the skin. The toe is numbed beforehand, ensuring the patient feels no pain during the procedure.
For a permanent solution, the PNA is often combined with a matrixectomy, which chemically destroys the nail root (matrix) beneath the excised section. This procedure, typically using phenol, prevents the removed portion of the nail from growing back, effectively curing the recurrent problem with a high success rate. This targeted removal leaves the majority of the nail intact while eliminating the source of the pain.
Special Considerations for High-Risk Individuals
Individuals with underlying health conditions should bypass self-treatment and primary care management, consulting a podiatrist immediately upon noticing an ingrown toenail. Patients with diabetes, peripheral artery disease (PAD), or neuropathy fall into this high-risk category. These conditions compromise blood flow and nerve sensation, impairing the body’s ability to heal and fight infection.
For patients with diabetes, a minor ingrown nail represents a serious risk for a rapidly spreading infection that can lead to severe complications, including foot ulcers and osteomyelitis. Neuropathy can mask the pain, allowing an infection to progress unnoticed until it becomes limb-threatening. Professional conservative care is the first-line approach, and surgical intervention is performed only after a careful vascular assessment.