# Involuted toenails > An involuted toenail is overly curved across its width; its most severe form is the pincer nail. Simple care comes first. A podiatrist can help if that isn't enough. Guide in [Skin and nails](https://footanklelowerlimb.com.au/learn/topics/skin-and-nails), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/involuted-toenail Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 1 November 2026. Next review by 1 November 2027. - **The nail is overly curved** across its width, and the most severe form is the pincer nail. - **For mild cases, simple care is usually tried first:** roomy shoes, keeping the nail a little longer and not trimming the sides, unless you have diabetes, poor circulation or nerve damage. ## What is an involuted toenail, and how common is it? An involuted toenail is a nail that curves too much from side to side [1]. The most severe form is a pincer nail (clinically, unguis constringens), where both sides curve towards each other [1][2]. It affects roughly 1 in 100 people, most often the big toe [3]. Many people first notice it in adulthood, as the curve slowly increases, and it often stays painless [2]. It differs from an ingrown nail by its shape: a pincer nail gets narrower and higher, while an ingrown nail has a normal shape [4]. ## What causes it, and who gets it? It isn't clear yet why involuted toenails develop [3]. They may be inherited or acquired [3][5]. Poorly fitting shoes are thought to be one of the most common causes [4]. Fungal nail infection and psoriasis are also linked with it, as are some medicines, such as beta-blockers [5]. It can help to check that your shoes aren't narrow or pressing on your toes. Regular medicines, psoriasis, eczema, fungal nail infection or past toe injuries can all be relevant to a nail problem. Don't stop a prescribed medicine because of a nail change: discuss it with the prescriber first [3][5]. ## What does it feel like, and how is it diagnosed? An involuted nail curls into the flesh without piercing the skin, usually on the big toe [6][3]. It may cause no pain, even in a full tube, or severe pain [2]. It can look red and inflamed [6] and make walking or shoes difficult [3]. A podiatrist or doctor diagnoses it from the nail's shape and an examination of your feet [3][7]. Note which toes are affected, whether the nail curves in at one or both sides, and when pain started and changed. Bring a list of your medicines and health conditions. ## What can I do first? Simple care comes first. Wear wide, comfortable shoes or sandals with room at the toes [8]. Soak the foot in warm salty water, then keep it dry [8]. Keep the nail a little longer and don't trim down the sides [1]. For pain, paracetamol or ibuprofen may suit you [8]. A podiatrist can show you how to tape the nail, tuck a little cotton wool or floss under its edge [9], or use a nail brace, which is designed to open the curve [2]. Taping may help in mild cases if it's done correctly and consistently [2]. Learn the technique first. No single first-choice treatment is agreed [10]. Simple care is easy to do, but the problem may come back or improve only temporarily [3]. Check a sore toe daily for the signs to watch for. ## What helps if that isn't enough? A podiatrist can assess whether a nail brace or splint, or partial nail removal (surgery on the nail edge and root), suits you. For ingrown nails, surgery is better at stopping the nail coming back than gutter splints, and probably better than braces [10]. For ingrown nails, adding phenol to the nail root after nail removal seems to reduce the chance of it returning [11]. Some experts advise trying conservative care first, because surgery can permanently change how the nail looks [12]. Ask about the chance of recurrence, healing time and any risks before agreeing to a procedure. ## How long does it take, and how can I stop it coming back? A pincer nail is a long-term problem that comes and goes, and that can affect quality of life [4]. Conservative care for a pincer nail is simple, but the problem may return or only improve for a time [3]. To help prevent an ingrown toenail, cut your toenails to the shape of your toe, without cutting them too short or rounding off the corners, and wear comfortable, well-fitting shoes [9]. ## What can make it serious? - An infection is getting worse, with more pain, redness, swelling or pus, but the redness isn't spreading and you feel well. - A spot, mole or sore on the skin of your foot or leg is new, changing, bleeding or not healing. - Redness from a wound, sore or infection is spreading into your foot or leg, or red streaks run up from it. - You have a foot wound, ulcer or infection, or a red, hot, swollen foot, and also have a fever, chills, a fast heartbeat or feel unwell. - Your foot, or a patch of skin on your foot or leg, becomes red, hot, swollen and painful. - You have diabetes or poor circulation and signs of infection in your foot, toe or nail, such as redness, warmth, swelling, pus, a bad smell or more pain. - You have diabetes, poor circulation or reduced feeling in your feet and notice a new wound, sore, blister or colour change on your foot, or a sore that isn't healing. - You have diabetes or poor circulation and an ingrown toenail. - You have pain in a bone with a fever. - You have a foot wound, ulcer or infection and also feel very unwell, with confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine (possible sepsis). ## Common questions ### Is an involuted toenail the same as an ingrown toenail? Not quite. An ingrown toenail is named for its symptoms, where the nail presses or pierces into the skin. Involuted and pincer nails are named for their shape, a nail that curves in too far. The two often occur together, and they have been confused for decades. ### Does a curved toenail run in families? Sometimes. The symmetrical form is probably inherited, and may involve a wide base or bony outgrowths on the toe bone beneath the nail. Other curved nails develop later in life for other reasons. If curved nails run in your family, a podiatrist can talk through what that may mean for you. ### How should I cut a curved toenail? Cut gently and keep it simple. Avoid picking at the nail or cutting down its sides, and don't dig around the edges with sharp tools, as this can damage the nail or skin and lead to infection. ## Further reading - [Involuted toenails on Clindice](https://clindice.com/involuted-toenail) - [Ingrown toenail: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/001237.htm), MedlinePlus - [Royal Orthopaedic Hospital - Nail Surgery](https://roh.nhs.uk/services-information/foot-and-ankle/nail-surgery), NHS - [Ingrowing toenail advice sheet with footwear](https://www.esht.nhs.uk/wp-content/uploads/2026/07/1198.pdf), NHS - [Ingrown Toenail v2 July 26](https://www.wmic.wales.nhs.uk/wp-content/uploads/2026/07/FINAL-PIL-Ingrowing-Toenail-v2-July-26-Eng.pdf), NHS - [Management of nail problems](https://www.chelwest.nhs.uk/your-visit/patient-leaflets/surgery-services/management-of-nail-problems), NHS ## Sources 1. Diabetes Nail Care Advice · Gateshead Health NHS Foundation Trust. https://www.gatesheadhealth.nhs.uk/wp-content/uploads/2023/09/Diabetes-Nail-Care-Advice.pdf 2. Controversies in the treatment of ingrown nails. · Haneke E · Dermatology Research and Practice · 2012. https://doi.org/10.1155/2012/783924 3. Pincer Nail Deformity: Clinical Characteristics, Causes, and Managements. · Huang C, Huang R, Yu M et al. · BioMed Research International · 2020. https://doi.org/10.1155/2020/2939850 4. A clinical study of 35 cases of pincer nails. · Lee JI, Lee YB, Oh ST et al. · Annals of Dermatology · 2011. https://doi.org/10.5021/ad.2011.23.4.417 5. Evaluation of nail abnormalities. · Tully AS, Trayes KP, Studdiford JS · American Family Physician · 2012. https://pubmed.ncbi.nlm.nih.gov/22534387/ 6. Nail disorders | Right Decisions · NHS. https://www.rightdecisions.scot.nhs.uk/borders-ref-help-toolkit/podiatry/nail-disorders/ 7. Ingrown toenails - treatment, symptoms, causes and prevention · Healthdirect Australia · 2026. https://www.healthdirect.gov.au/ingrown-toenails 8. Ingrown toenail · NHS · 2017. https://www.nhs.uk/conditions/ingrown-toenail/ 9. Ingrown toenail · Health New Zealand | Te Whatu Ora. https://www.healthnz.govt.nz/health-topics/conditions-treatments/feet-and-ankles/ingrown-toenail 10. Interventions for ingrowing toenails. · Eekhof JAH, Van Wijk B, Knuistingh Neven A et al. · The Cochrane Database of Systematic Reviews · 2012. https://doi.org/10.1002/14651858.cd001541.pub3 11. A systematic review and meta-analysis of randomised controlled trials on surgical treatments for ingrown toenails part I: recurrence and relief of symptoms. · Exley V, Jones K, O'Carroll G et al. · Journal of Foot and Ankle Research · 2023. https://doi.org/10.1186/s13047-023-00631-1 12. Improvements in pincer nail deformity occur earlier and last longer when acetylcysteine gel is added to an overcurvature-correcting device: Results of a phase 3, multicenter, randomized, vehicle-controlled, investigator-blinded study. · Saito M, Ikoma A, Fujikawa A et al. · The Journal of Dermatology · 2024. https://doi.org/10.1111/1346-8138.17010 --- This is general information, not advice about your own situation. To discuss your issues, book with one of our podiatrists. In an emergency, call 000.