Article · nail fold · ingrown toenail

Painful nail fold: treat the cause, not just the redness

Pain, redness and swelling around a nail are common. They do not always mean that the missing treatment is an antibiotic. If the edge of the nail is pressing into the skin, an antibiotic may calm inflammation for a while, but it does not remove the pressure from the nail.

Book an assessment for a nail problem See common causes

This article is written for patients and healthcare professionals. It does not replace individual clinical assessment.

Medically reviewed 2 July 2026 · Markus Huotari, general practitioner

Care route

When should I book, call 116117 or call 112?

Book an appointment if

the nail fold is red, painful, draining or the problem recurs
you need to distinguish ingrown nail, abscess, irritation, granulation tissue and retronychia
you need a decision on local care, antibiotics or a procedure assessment

Call 116117 if

redness spreads, fever develops or pain worsens quickly
you have diabetes, impaired circulation or sensation, immunosuppression or severe chronic illness
there is a wound, trauma, marked swelling or suspected deep infection

Call 112 if

there is chest pain, severe shortness of breath, impaired consciousness, stroke-like symptoms or another emergency
general condition deteriorates rapidly or the person cannot stay awake
bleeding, pain or injury feels immediately life-threatening or function-threatening

This is not an emergency department. At the appointment the aim is to examine the situation and decide the next sensible step: self-care, medication, a minor procedure, tests or referral.

Book a nail-fold assessment See the guidance on this page

Key message

First identify the cause. Then choose the treatment.

A nail fold can be red and tender even without a true bacterial infection. A hard nail can press into soft skin. The skin reacts much like it would to a small object rubbing against it: it becomes painful, swollen and may start to discharge. [1]

Sometimes there is a true pocket of pus, an abscess, and the pus needs to be drained. Sometimes the problem is long-term irritation, moisture-related inflammation or abnormal nail growth. In chronic inflammation at the base of the nail, retronychia is a cause worth actively looking for surprisingly often: it is a growth disturbance or injury in the nail base, the matrix area, where the nail can no longer grow forward normally. [2] [6] [10]

Why this happens

The nail is a hard plate next to soft skin.

The skin beside the nail is the nail fold. When the nail edge grows, curves or presses into the skin, it can cause pain and an inflammatory reaction. Common background factors include tight shoes, repeated pressure on the toe, cutting the nail too deeply at the side and the nail's own growth pattern. [1] [4]

If the pain is at the base of the nail, the mechanism may be different. In retronychia, the nail does not grow forward normally and becomes pushed back into the base of the nail. A standard procedure on the side edge of the nail usually does not solve that problem. [6] [10]

Common causes

What can cause a painful nail fold?

Situation	What it often looks like	What treatment depends on
Mild irritation or early ingrowth	The nail fold is tender and red, but there is no pus and the redness is not spreading.	The key is often to reduce pressure: roomier shoes, correct nail trimming, local care and follow-up.
Ingrown nail and granulation tissue	The nail edge presses into the skin. There may be easily bleeding tissue, discharge and pain when walking.	If the same nail edge keeps irritating the skin, ointment or antibiotics alone often do not solve the cause. Partial nail removal may be considered.
Acute paronychia and possible abscess	Pain starts quickly. The nail fold becomes swollen, hot and may discharge pus.	If there is an abscess, it usually needs to be drained. Antibiotics may be needed if infection spreads or the patient has special risk factors.
Long-lasting paronychia	The problem continues for weeks. The cuticle may be damaged, the skin irritated and the nail uneven. Several nails may be affected.	The background may be moisture, skin irritation, eczema or another skin condition. Treatment focuses on reducing irritation and calming the skin.
Retronychia	Pain is at the base of the nail. The nail may be yellowish, thickened, lifted or layered. The patient may notice that the nail no longer seems to grow forward.	The problem is not at the side edge but at the base of the nail. In mild cases pressure is reduced. In persistent or painful cases total nail removal may be needed.
Another diagnosis	There may be unusual dark colour, a non-healing sore or crust around the nail, a clear lump, nail separation, rash, fungal disease or another atypical finding.	The problem should not automatically be treated as an ordinary infection. Sometimes fungal testing, dermatology assessment, biopsy or other investigation is needed.

Clinical assessment

What is assessed during the appointment?

The first question is where the pain is: at the side edge of the nail or at the base of the nail. That matters a lot. A nail-edge problem and a growth problem at the nail base are different mechanisms, rather like a door catching at the bottom versus a problem at the hinge. I also assess whether there is an abscess under the skin, whether the nail edge is pressing into the skin, whether there is granulation tissue, whether the findings suggest retronychia and whether the patient has diabetes, poor circulation or another high-risk foot feature. Treatment is chosen only after this: sometimes local care and pressure reduction are enough, and sometimes abscess drainage, partial nail removal, total nail removal or referral is needed. [5] [9]

If a nail problem is linked to diabetes, poor circulation, reduced sensation or a previous foot ulcer, I do not treat it as an ordinary nail problem. Assessment of diabetic foot problems and significant foot-ulcer risk belongs with an experienced foot team when needed, and I refer there with a low threshold.

Antibiotics

When do antibiotics help, and when do they not?

An antibiotic may be appropriate if redness is spreading in the toe or foot, the patient has fever, the infection is severe, or the patient has diabetes, poor circulation or reduced immune defence. [2] [9]

If there is an abscess, the pus usually needs to be drained. If the nail edge is pressing into the skin, antibiotics do not remove the pressure from the nail. It is a bit like treating a stone in the shoe with painkillers: the symptom may settle for a while, but the mechanical cause remains. The key question is therefore: what is causing the nail fold pain and redness? [5]

Procedures

The procedures are not the same thing.

Nail fold problems are often discussed with overlapping terms. For the patient, it matters what is actually being done and why. [4]

Abscess drainage

A pocket of pus is opened and drained. This treats the pus, but does not always remove the cause of an ingrown nail.

Partial nail removal

The painful edge of the nail is removed under local anaesthesia. The aim is to remove the nail edge that is pressing into the skin.

Phenolisation

The nail-growing area is treated so that the same narrow edge is less likely to grow back. This is not done for brief irritation alone, because the purpose is to destroy part of the nail-growing area.

Wedge excision

A wedge of nail fold skin or granulation tissue is removed. This is a different procedure from removing the nail edge.

Total nail removal

The whole nail is removed. This may be considered in severe fungal nail disease, a badly damaged nail or retronychia.

Biopsy or referral

If the finding is unusual, long-lasting, dark, non-healing, easily bleeding or tumour-like, biopsy or specialist assessment may be needed.

Partial removal and phenol

When should the nail edge be removed?

In partial nail removal, a narrow part of the nail edge is removed. It is considered when the same nail edge repeatedly presses into the skin, pain affects walking, or the nail fold has developed granulation tissue and discharge. [1] [4]

If the problem keeps recurring from the same edge, phenolisation may be added. This treats the nail-growing area so that the same edge is less likely to grow back in the same way. Phenolisation is considered when the aim is to prevent recurrence from the same nail edge. It is not suitable for temporary rubbing or mild irritation, because the treatment targets the nail-growing area and is intended to narrow nail growth more permanently. [3]

Technique matters. If a small nail spike remains or part of the nail-growing area remains active, the problem can return. [4] [8]

Total nail removal

When is total nail removal considered?

Total nail removal is not the basic treatment for an ordinary ingrown toenail. It can make sense when the whole nail is the source of the problem. This may be the case in severe fungal nail disease, a badly thickened or detached nail, after trauma, or in retronychia.

After total nail removal, the nail bed is initially tender because the protective nail is missing. The wound settles over weeks. A toenail grows back slowly: in a healthy toe, the nail may in practice approach its previous length in about 6 months, but there is considerable variation. The cosmetic appearance may be poor for about a year. If the nail-growing area has been damaged, the new nail may remain thickened or uneven. [8]

Nail base

Retronychia is an ingrown nail at the base of the nail.

An ordinary ingrown nail usually causes trouble at the side edge. If the pain is at the root of the nail rather than at the side edge, the problem may not be an ordinary ingrown nail edge. In retronychia the mechanism is reversed: the nail cannot slide forward normally, and its back edge presses into the base of the nail. Pain, swelling and possible granulation tissue are therefore at the base of the nail. [6] [10]

The trigger may be a blow to the toe, repeated big-toe trauma during football as a hobby, running, tight shoes or another situation where the toe repeatedly presses into the front of the shoe. When nail growth is disturbed, a new nail starts growing under the old nail. The old nail does not detach or move forward normally, and several nail plates may stack on top of one another. This irritates the skin at the nail base and can look like ordinary paronychia. [10]

Retronychia is easily missed because it can resemble infection or fungal nail disease. Useful clues include pain at the nail base, yellowish or white nail colour, thickening or lifting of the nail, loss of the cuticle, granulation tissue at the base, and the impression that the nail is not growing forward. If the problem is at the base, a standard procedure on the side edge usually does not help because it targets the wrong area. [6] [10]

In mild cases, pressure can be reduced, shoes changed, the toe protected and inflammation calmed. In persistent and painful retronychia, total nail removal may be the best way to confirm the diagnosis and treat the problem. Several stacked nail plates may be found under the removed nail. This explains why the problem did not behave like an ordinary infection treated with antibiotics. [7] [10]

Remote assessment

A nail problem is often hard to assess from a photo alone.

A photo may show redness, granulation tissue and the shape of the nail. It does not always show whether there is an abscess under the skin, how deeply the nail edge is pressing, or whether the pain is at the side or at the base of the nail. These details affect treatment.

A remote assessment can help clarify urgency or check an aftercare instruction that has already been given. The actual mechanism of a nail problem often becomes clear only in an in-person appointment, where the location of pain, possible abscess and the way the nail presses into tissue can be examined. An in-person appointment is usually better if pain affects walking, discharge increases, redness spreads, the patient has fever, or the foot is high-risk because of diabetes or poor circulation. [9]

Warning signs

When should a nail fold be assessed more urgently?

rapidly spreading redness, heat or swelling from the toe toward the foot
fever, clear worsening of general condition or severe increasing pain
diabetes, poor circulation in the foot, reduced sensation, reduced immune defence or a previous foot ulcer
a black, blue or clearly circulation-related change in the toe
unusual pigmentation, a non-healing sore or crust around the nail, a persistent lump in one nail area or a tumour-like finding
112 Finland: when to call the emergency number
Medical Helpline 116117

Evidence

What does the evidence say?

There are many studies on procedures for ingrown toenails, although the quality of studies varies. The practical message is still clear: if the same nail edge keeps growing back into the same place, simple edge removal tends to recur more often than edge removal combined with treatment of the nail-growing area, such as phenolisation. [3]

This does not mean that phenolisation is always needed. It is considered when the aim is to prevent recurrence from the same nail edge. If the problem is only brief rubbing or pressure, there is no reason to destroy the nail-growing area. [4]

Failure after partial nail removal is often technical: a small nail spike may remain, or part of the nail-growing area may remain active. The patient then experiences that the nail was cut, but the problem came back. [4] [8]

In acute paronychia, the key is to recognise an abscess. If an abscess has been drained well, antibiotics are not always needed. If infection spreads, the patient has fever, diabetes, poor circulation in the foot, reduced sensation or a previous foot ulcer, antibiotics or more urgent further assessment may be needed. The evidence base for retronychia is smaller, but clinical descriptions are consistent: pain is at the base of the nail, the nail may layer, and in difficult cases total nail removal can both confirm the diagnosis and treat the problem. [5] [6] [7] [10]

Practical rule

The first good question is not "which medicine?", but "what is causing this?"

Is the pain at the side edge of the nail or at the base?
Is there an abscess or irritated tissue?
Is the nail edge pressing into the skin?
Is granulation tissue caused by ongoing friction?
Is the problem long-lasting, present in several nails or linked to eczema?
Does the patient have diabetes, poor circulation in the foot, reduced sensation or a previous foot ulcer? Then the nail problem should not be treated as an ordinary nail complaint; assessment should be sought with a clinician or service experienced in diabetic foot care.

Booking details

What is useful to mention about a nail-fold problem?

whether the pain is at the nail edge, nail base or around the whole nail
whether it started after a blow, repeated big-toe trauma in football as a hobby, running, tight shoes or repeated pressure
whether there is pus, granulation tissue, nail lifting or a feeling that the nail is not growing forward
whether you have diabetes, poor circulation, reduced sensation or a previous foot ulcer

A photo can help, but the actual cause often becomes clear only when the painful point and the way the nail presses into tissue are examined.

Sources and review

What this page is based on

This page was written and reviewed by Markus Huotari, general practitioner. Content checked on 2 July 2026.

Other appointment situations

Partial nail procedure in HelsinkiAssessment of an ingrown or inflamed nail and whether a procedure is useful. Minor procedures with a GPFirst clinical assessment, then a procedure when safe and useful. Abscess drainage in HelsinkiAssessment and, when appropriate, drainage of an abscess. General practice urgent care in TöölöAcute GP assessment: urgency, tests, treatment plan and next steps.