Why Everything You Think You Know About Ingrown Toenails Is Probably Wrong
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.
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