Ingrown Toenail vs Paronychia of Big Toe

Ingrown toenail is a health concern of patients coming for consult and treatment.  Onychocryptosis is the technical medical term for ingrown toenail.

Ingrown toenail

Ingrown toenail is a condition usually present on a big toe.  It is caused by a trauma,  puncture or constant friction by a portion of nail plate, usually the side part, on the nail fold.  Wearing tight-fitting shoes and improper trimming of toenails are risk factors for ingrown toenails.

There is usually pain, swelling, erythema (redness), oftentimes with pus and breakdown of the skin and tissue (flesh) along the side of the nail.   In long-standing situation, there is breakdown and thickening of the skin and tissue (flesh) adjacent to the ingrown toenail.

One has to differentiate ingrown toenail from a disease called paronychia that occurs in the big toe and that can present with the same symptoms as those for patients with an ingrown toenail. It is important to differentiate the two as the treatment for the two diseases are not the same. Ingrown toenail may require removal part of the nail whereas paronychia does not, just control of the infection.


Paronychia is a skin infection that occurs around the nail.  It is caused by an injury to the nail fold (flesh along the side of the nail) by whatever cause except by the nail itself as is the case in ingrown toenail.

In the acute stage, the symptoms of patients with paronychia of the big toe consist of the  affected area usually being painful, swollen, red, and at times, contains pus.  These are essentially similar to the symptoms presented by patients with ingrown toenails.

A thing that can differentiate the two, short of an operation that examines the real situation under anesthesia, is that paronychia usually resolves within a week’s time with proper control of infection.  If the infection is recurrent and there is marked thickening of the flesh adjacent to the nail, then most likely, the culprit is an ingrown toenail.

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3 Responses to Ingrown Toenail vs Paronychia of Big Toe

  1. Kim says:

    I have been diagnosed with Paronychia of my left thumb nail. The pain is soooo bad. Cannot even put pressure on my finger. I could have sworn it was an ingrown nail at the base of my nail. Not sure if I was diagnosed correctly. How can you tell the difference when just looking at the finger? The doctor at urgent care seemed sure, but didn’t tell me how she was so sure.

    • reyojoson says:

      Ask for a second opinion. The second doctor will have to take a look at your thumb nail. Cannot be done by description. Dr Rey

      • Kim says:

        Thank you for your reply. Since starting prednisone, Clindamycin yesterday, the pain has gotton much better and the swelling has started to go down. I’m just thinking ahead and worried that after I stop the meds, it may come back if it is an ingrown nail, the problem will still be there. Just not sure when to get that 2nd opinion. I have a call in to my primary care physician for a referral for someone who would actually remove it if it is an ingrown fingernail.

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