Why Do Some Ingrown Toenails Return?

Few things are more frustrating than believing your ingrown toenail has healed, only to have the same pain return a few months later.

Many patients assume they have done something wrong.

In most cases, they haven't.

Recurring ingrown toenails usually occur because the underlying cause has never been fully corrected.

Treating the inflammation may settle the symptoms temporarily, but unless the reason the nail became ingrown is addressed, recurrence remains possible.

The Nail Grows Back Exactly the Same

A temporary partial nail avulsion removes the offending edge of the nail.

However, if the nail matrix is left untouched, the nail simply grows back with exactly the same shape it had before.

If that nail was naturally curved, thick or prone to growing into the surrounding skin, it will often do so again.

This is why temporary procedures have a higher recurrence rate than permanent procedures in patients with recurrent disease.

Natural Nail Curvature

Some people naturally have highly curved toenails.

As the nail grows, the edges naturally curve downward into the surrounding skin.

This is determined largely by anatomy and genetics rather than anything the patient has done.

No amount of careful nail cutting can permanently change this natural curvature.

Thickened Nails

A thicker nail plate behaves differently from a thin flexible nail.

Thick nails place greater pressure on the surrounding soft tissues and are often more likely to become embedded.

Causes of thickened nails include:

  • Previous trauma.
  • Ageing.
  • Fungal nail disease.
  • Repeated sporting injuries.

Treating the underlying nail condition may sometimes reduce recurrence.

Soft Tissue Overgrowth

Sometimes the problem is not only the nail.

The surrounding skin may become enlarged through:

  • Chronic inflammation.
  • Repeated infection.
  • Hypergranulation tissue.
  • Natural anatomy.

When excess tissue repeatedly folds over the nail edge, even a relatively normal nail can become ingrown.

Repeated Trauma

Occupations and sports that repeatedly compress the toes may continually aggravate the nail.

Examples include:

  • Football.
  • Soccer.
  • Running.
  • Construction work.
  • Steel-capped boots.
  • Hiking.

The repeated pressure may contribute to recurrent symptoms even after previous treatment.

Poorly Controlled Medical Conditions

Certain medical conditions may increase the likelihood of recurrent nail problems or delayed healing, including:

  • Diabetes.
  • Peripheral vascular disease.
  • Chronic swelling.
  • Immune suppression.

These conditions do not necessarily cause the ingrown toenail but can influence recovery and recurrence.

Evidence Update

The strongest predictors of recurrence include persistent nail curvature, incomplete correction of the underlying anatomy and failure to address the nail matrix in patients with recurrent disease.

Patient Tip

If your ingrown toenail keeps returning despite careful nail cutting and good footwear, the underlying anatomy rather than your technique may be responsible.