Not All Sore Toenails Are Ingrown — Paronychia Explained

What is Paronychia?

Paronychia is an inflammation or infection of the skin beside the nail — most often where the nail meets one or both sides of the toe. It’s a common cause of nail pain and swelling and is often mistaken for an ingrown toenail.

There are two main types:

Acute Paronychia: this type appears suddenly, usually due to bacteria entering through a small cut or bit of trauma — like trimming the nail too short or bumping the toe.

Chronic Paronychia: this develops more slowly and may linger for weeks or longer. It’s often linked to repeated irritation, moist environments, or fungal involvement — such as sweaty socks or tight shoes.

Common Signs of Paronychia

• Redness and swelling around the nail fold

• Pain or tenderness to touch

• Pus or discharge (in acute cases)

• A feeling of pressure or throbbing

• Nail plate changes or separation over time

What Causes Paronychia?

Nail Trauma & Microtrauma

Damage to the nail fold from:

• Cutting toenails too short or excessively rounding the edges

• Nail biting or picking

• Stubbed toes or dropping something on the foot

• Tight or ill-fitting shoes

• Repetitive pressure from activities like running or sport

Moisture Exposure

Prolonged dampness softens skin and weakens its defences:

• Sweaty socks or enclosed shoes

• Swimming, showering, or soaking feet

• Frequent cleaning or wet work without gloves

Irritants & Allergens

These are more common in chronic paronychia:

• Soaps, detergents, or chemicals

• Nail products (polish remover, glues)

• Allergens such as Latex gloves

Paronychia vs Ingrown Toenail

It’s easy to confuse the two — but they’re not quite the same.

An ingrown nail (onychocryptosis) happens when the nail plate curves and pierces the surrounding skin. This often stems from poor trimming or an excessive curve in the nail.

Paronychia, on the other hand, is when the nail fold becomes inflamed or even infected — often mimicking an ingrown nail, but without actual nail penetration.

Sometimes they occur together — but often that angry red swelling is paronychia alone.

How Is Paronychia Treated?

Treatment depends on whether the paronychia is acute or chronic.

For acute cases:

• Warm saltwater soaks

• Topical antiseptics or antibiotics

• Drainage if pus or abscess is present

• Nail edge trimming or minor in-clinic procedure (if an ingrown component is involved)

For chronic cases:

• Identifying and avoiding triggers (like water or irritants)

• Antifungal or steroid creams

• Gentle nail care and footwear changes

• Regular hygiene and podiatry monitoring

At New Step Podiatry, we may also carry out in-clinic nail procedures to reduce pressure or allow healing — all tailored to your individual case.

What About Retronychia?

Retronychia is a rarer condition where the nail begins to grow backwards into the nail matrix — usually after trauma or repeated pressure.

Signs may include:

• Thickened or discoloured nail

• Redness and pain at the base of the nail

• The nail not growing forward properly

• Multiple nail plates layered beneath each other

It can look similar to paronychia or an ingrown nail. Retronychia may require a podiatrist to burr/thin the toenail plate or surgically remove the toenail to allow a healthy one to grow back.

When to Seek Help

If your toenail is red, swollen, or painful — and home remedies aren’t helping — it’s time to get it assessed.

What seems like a straightforward “ingrown nail” may actually be paronychia, retronychia, or another nail condition entirely. Getting the diagnosis right matters — and we’re here to help.

At New Step Podiatry, we’ll work with you to find the cause and tailor the right treatment plan, so you can walk away in comfort.