Blog, Ingrown Nails
A conversation with a podiatrist who has seen it all
Ingrown toenails are not glamorous. They do not trend well on Instagram unless they are extreme, infected, and frankly horrifying. And yet, according to one podiatrist with three decades of experience, they are also among the most misunderstood foot problems in modern health care.
I sat down with Dr Brenden Brown, an AHPRA-registered podiatrist with 30 years of experience and former President of the NSW Podiatry Council, to talk about the myths that keep patients in pain far longer than they need to be.
“Ingrown toenails sit in this strange space,” he says. “They’re common, they’re painful, but they’re also surrounded by old wives’ tales, internet nonsense, and a lot of unnecessary fear.”
The V-cut myth, and why his dad still believes it
If you have ever mentioned an ingrown toenail at a barbecue, someone has likely offered this advice: cut a V into the middle of the nail, and it will magically pull the sides away from the skin.
Brown laughs when I bring it up.
“I still argue about this with my dad,” he says. “To this day, he is convinced that cutting a V in the middle of the toenail makes it grow inwards and lift away from the sides. I keep telling him, either you’re wrong, or Dad, you wasted all that money helping me through Uni, and thirty years later, I still don’t know what I’m talking about.”
The problem, he explains, is a basic misunderstanding of how nails grow.
“Toenails only ever grow from the base. They do not grow from the sides, and they certainly do not respond to clever shapes cut into the tip,” he says. “What happens with the V-cut is a bit of an optical illusion. As the nail grows forward, you keep trimming the top, so it looks like the V is closing in. In reality, you’re just cutting the end off again and again. The sides are doing exactly what they were doing before.”
At best, he says, a V-cut might reduce pressure very slightly.
“But it’s not because the nail is growing away from the skin. Biologically, that just isn’t how nails work.”
Social media has made everyone think surgery is inevitable
Another misconception Brown sees daily is the belief that an ingrown toenail automatically leads to surgery.
He blames the algorithm.
“People don’t Google anymore, they go straight to YouTube or Instagram,” he says. “And those platforms are designed to show you the most extreme, feral-looking ingrown toenails imaginable. They get shared, they get watched longer, and they completely skew people’s expectations.”
The result is that patients often arrive anxious, embarrassed, and convinced they are about to lose a nail.
“The reality is that the vast majority of ingrown toenails never get anywhere near that stage,” Brown says. “Most people will never need surgery. And they certainly won’t need their whole nail removed.”
Conservative management before surgery is consistent with accepted podiatric clinical guidelines.
In reality, when surgery is needed for ingrown toenails, it is usually because the problem has been recurrent, severe, or left untreated for too long.
In fact, in thirty years of practice, he can count the number of total nail removals he has performed on one hand.
“I’ve probably removed four entire nails in my career. That’s it,” he says. “That statistic alone usually stops people in their tracks.”
Surprisingly, while Dr Brown might familiarise himself regularly with evidenced-based articles around ingrown toenails, the average person on the street isn’t trolling the pages of professional publications published by The Australian Podiatry Association and alike.
Why antibiotics and creams keep failing
One of the more frustrating myths, according to Brown, is the belief that antibiotics or topical creams will fix the problem on their own.
“An ingrown toenail behaves like a splinter,” he explains. “You’ve essentially got a piece of nail acting as a foreign body embedded in the skin. The body reacts exactly as you would expect. Redness, swelling, heat, and sometimes pus. That doesn’t automatically mean infection is the primary problem.”
This is where well-meaning treatment can go astray.
“What often happens is that someone is prescribed antibiotics, sometimes repeatedly, because the area looks inflamed,” he says. “But antibiotics don’t remove the nail spike. They calm things down temporarily, and then the problem comes straight back.”
Brown is careful not to criticise general practitioners.
“They’re doing their best with the information in front of them,” he says. “But if you don’t remove the foreign body, you haven’t solved the problem. You’ve just delayed it.”
What actually happens at a first podiatry visit
For many patients, the fear of treatment is worse than the condition itself.
“They imagine they’ll need injections, stitches, time off work, someone driving them home,” Brown says. “Most of the time, none of that is true.”
In early or moderate cases, treatment can be remarkably simple.
“Often there’s just a small spike or spicule of nail that’s been left behind, usually from poor cutting technique or enthusiastic DIY attempts,” he explains. “That spike grows straight up into the skin and causes irritation.”
Using a fine instrument, sometimes without any local anaesthetic at all, the offending edge can be removed.
“It can take fifteen minutes,” Brown says. “People are often shocked at how straightforward it is.”
Simple Treatment Starts Here
The myth that nail shape is the whole story
While some people do have naturally curved or wide nails, Brown says nail shape is only part of the picture.
“Footwear plays a massive role,” he says. “So does repeated pressure, sweating, softening of the skin, and even how active someone is.”
This is why blanket advice often fails.
“You can’t just say, ‘Your nails are curved, bad luck,’” he says. “You have to look at the whole environment the nail is living in.”
Why early treatment matters, even if it sounds self-serving
Brown is upfront about one piece of advice he gives almost every patient.
“I always say, get it treated sooner rather than later,” he says. “And I know that can sound self-serving coming from a clinician.”
But experience backs it up.
“The earlier we see it, the more conservative the treatment can be. The longer someone waits, the more inflamed the tissue becomes, and the narrower the options get.”
Ironically, fear of treatment is often what leads people to need more intervention.
“People put it off because they’re scared,” he says. “And that’s exactly what pushes things in the wrong direction.”
The quiet message most people need to hear
If there is one takeaway Brown hopes people remember, it is this.
“Ingrown toenails are common, treatable, and rarely dramatic when managed properly,” he says. “Most of the horror stories online are the exception, not the rule.”
And yes, he still hasn’t convinced his dad to stop cutting that V.
“But I’m working on him,” he says, smiling. “Thirty-one years might be the charm.”
This article is general information only. Treatment varies between individuals, so it does not replace assessment and advice from a qualified health professional.
Book an Appointment and Stop the Pain
Other Blogs About Ingrown Toenails
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Have you ever wondered why you’re not getting better after seeing a therapist, and what you can do about it? Dr Brenden Brown, the Leading Podiatrist at A Step Ahead Foot and Ankle Care, Penrith, explains that it could be you, not the therapist. It’s Father’s Day. I love my dad, and I’m sitting in […]
Blog, Heel Pain
5 tips to help you beat your heel pain !
The good news? Heel pain can be fixed, and often faster than you think. After years of helping thousands of patients across Sydney, we’ve refined what really works. Here are our top five tips that make the biggest difference.
- Pain’s a signal, not a stop sign
Back when this blog first came out (yes, around fourteen years ago!), we used to say, “If it hurts, stop.” But today, we know a lot more about how your body recovers.
Pain is information, not punishment. It’s your body’s way of saying, “I’m not coping with this load right now.” That doesn’t mean you have to stop everything. If you normally run 10 kilometres and the pain starts at 8 km, pull up there. If you walk 5 km and your heel pain begins to bite at 4 km, finish early, not forever.
Completely resting can actually make things worse; we’d then need to reload the tendon later, which can restart the pain cycle. The goal is to find your “sweet spot,” enough activity to keep tissues strong without over-irritating them.
“Pain is your body’s information system, not a punishment. We use it as feedback to guide your recovery, not as a reason to panic.”
— Dr Brenden Brown, Podiatrist
A little bit of discomfort is okay; crippling pain isn’t. The art (and science) of modern recovery is learning to listen to those messages and pace smartly, not push blindly.
- Nothing will change unless YOU change it
Fourteen years ago, we wrote this same tip, and it’s still true today, maybe even more so.
If your heel pain hasn’t improved after weeks (or months) of doing the same thing, it’s time to change something.
Maybe you’ve been following Dr Google’s advice to “stretch your calves” for Achilles pain or “roll a frozen water bottle” for plantar fasciitis. The truth? That’s yesterday’s science. For many types of heel pain, stretching can actually slow healing. What your heel really needs is smarter loading, the right amount of stress at the right time to help the tissue rebuild.
And here’s where the right guidance matters. Not every podiatrist spends their days fixing heel pain. Many focus on good old general foot care, such as helping your nan with her corns, calluses, and nails. There’s nothing wrong with that, and they do it brilliantly. But at A Step Ahead Foot + Ankle Care, our doctors see six to eight heel-pain patients every day. Which means we’ve become Western Sydney’s leading experts on heel pain. That’s thousands of hours of focused experience, well past the “10,000 hours” rule described by researcher Dr Anders Ericsson and popularised by Malcolm Gladwell in Outliers: The Story of Success.
“If your treatment hasn’t changed in months and your pain still has, it’s time to change your approach.”
— Dr Brenden Brown, Podiatrist
If your current plan keeps you stuck, it might not be the right plan. Fresh eyes, updated evidence, and a specialist who truly understands heel pain can make all the difference.
You Don’t Have to Put Up With This
- Stick to the plan
This one sounds simple, but it’s often the hardest part. We see it every week: someone comes in frustrated that their heel pain isn’t improving, only to discover they’ve been mixing and matching advice.
Maybe a friend at the gym swore by a new stretch they saw on TikTok. Perhaps you decided the shoes we recommended weren’t really your style. Or maybe you thought skipping a few therapy sessions wouldn’t hurt.
The truth is, the people who get better fastest are the ones who follow the plan. We build your treatment schedule, exercises, and footwear program around thousands of hours of experience treating heel pain. These plans aren’t random. They’re built on evidence, careful assessment, and an understanding of how your body actually heals.
“Our Doctors are all qualified, board-certified Podiatrists; they didn’t just roll out of bed and decide they were heel-pain experts. They spent five years at university and have thousands of clinical hours treating this exact condition.”
— Dr Brenden Brown, Podiatrist
5 Tips to Help You Beat Your Heel Pain
Your plan is your map out of pain. Stick to it, communicate with your clinician, and resist the urge to detour through online shortcuts. Consistency is what turns improvement into recovery.
Don’t believe us? Then how about this excellent one-page infographic, produced by the Journal of Orthopaedic and Sports Physical Therapy, that helps patients understand what high-value treatments look like?
- Understand what is happening
Understanding your condition is half the battle. Know what it is, what causes it, what aggravates it, and why each part of your treatment exists. When you know the “why,” sticking to the “what” becomes much easier.
If something is unclear, ask. Ask again if you need to. A good clinician welcomes your questions and explains things in plain English. If you get a one-liner like “It’s plantar fasciitis and you need very hard orthotics,” that is not enough information for most people to succeed.
In our clinic, we explain what is going on in your foot, how load is affecting the tissues, which habits are stirring things up, and how each step of the plan helps your body adapt.
If you feel under-informed, speak up. Your recovery works best when you know what is happening and you are part of the decision-making.
If you need a plain-English overview for Achilles heel pain, see this easy-to-understand patient guide.” We genuinely want our patients to be educated on their condition. This means being up to date with the evidence base. All clinicians should want their patients to be as educated as possible!
- Finally, DON’T give up!
Whether you have just started your journey to being pain-free or you have tried multiple options from different practitioners with no success, very seriously, do not give up. We are often people’s third or fourth opinion for their plantar fasciitis heel pain. Some patients have seen physiotherapists, specialists, GPs, and other podiatrists. If you have not had success yet, please don’t give up; you are not alone. We have helped literally 1000’s of patients just like you!
“I have the privilege of watching patients report less pain each week until it is gone. Just like people, every foot is different, and the causes of heel pain are different. When your case is carefully analysed, correctly diagnosed, and properly treated, wonderful things can happen. Our approach is very specific to you and how your body responds.”
— Dr Brenden Brown, Principal Podiatrist
These are our top five because we see these patterns so often. It is unusual to meet someone who isn’t dealing with at least one of them. The good news is that heel pain can be beaten. You don’t have to keep battling it or letting it limit your activity. You can get back to the things you love.
We regularly see patients who travel from all across Sydney and even interstate to visit our clinic. It’s not unusual for us to be the last of a long line of practitioners they’ve seen. Come and join our growing group of pain-free patients; we would love to help you, too.
Our clinic is located in St Mary’s, Western Sydney, just five minutes from the M4 with miles of parking out the front. If you’re ready to get on top of your heel pain, we would love to see you head to Penrith and see our super-friendly team of foot doctors.
Book an Appointment and Stop the Pain
Other Blogs About Heel Pain
Posted: 15/09/2015
Do you want to get fit but, are getting held up by foot ankle or lower limb pain. Dr Brenden Brown recalls a case study of a patient and how she got back to fitness
Posted: 23/06/2017
What do you do if your child has foot, ankle or lower limb pain + you cant find answers. We explore how common it is to hear kids told there is nothing wrong when in obvious pain – this case study helps with answers
Posted: 04/09/2017
He’s just not as fast as the other kids, and limps a little after games! I thought it would just go away but it seems to be getting worse Sound familiar? Ashley came to see us after a frustrating 4 weeks of Heel Pain for mum and daughter alike. Stretching and Rest had been prescribed […]
Posted: 07/09/2017
Top 6 reasons your heel pain IS NOT getting any better! This article was initially written in 2014 and has helped literally thousands of people. As it was written in 2014 I decided it was time I got back to this and updated with some fresh new information!
