Pincer Toenail: Causes and Treatments

A pincer toenail, also known as a trumpet nail or an in-curved nail, is a painful ingrown toenail that occurs when the nail plate curves in. The sides of the nail curve in, pinching the surrounding skin.

A pincer toenail causes the skin to become red, tender, and swollen. It also raises the risk of infection. 

Common causes of pincer toenails include chronic (long-term) health conditions, tight shoes, and certain medications. A podiatrist (a medical doctor who specializes in diagnosing and treating conditions of the feet) can provide treatment options for pincer toenails. 

Pincer toenails usually develop slowly over time. This nail deformity causes the nail to appear curved, most prominently at the tip. The nail plate may also look thicker than the other nails and feel difficult to trim. 

As a pincer toenail progresses, the sides of the nail curve inward and may eventually form the shape of a tube. When the nail grows into the skin, it causes pain, redness, and inflammation. People with a pincer toenail may experience frequent nail or skin infections.

A pincer toenail is a common nail deformity and can be hereditary or acquired. In most cases, a pincer toenail develops slowly over time. 

Tight Shoes

Regularly wearing tight shoes raises the risk of pincer toenails. Tight shoes squeeze the toes together, curving the nail plate over time. Years of wearing tight shoes can cause the nail to become permanently curved. It usually takes years for pincer nails to develop.

Pincer toenails are more common in people who wear high heels because those types of shoes put extra pressure on the toes. 

Chronic Health Conditions

Some chronic health conditions raise the risk of pincer toenails because they affect blood flow or oxygen supply to the nails. Chronic health conditions that may cause pincer toenail include:

• Kidney (renal) failure
• Kawasaki disease, a condition causing inflammation of the blood vessels
• Systemic lupus erythematosus (lupus), a chronic autoimmune disease
• Amyotrophic lateral sclerosis (ALS), a neurodegenerative disease that weakens muscles

A pincer nail will usually resolve once these conditions have been effectively treated. 

Certain Medications

Certain medications may affect foot and nail health.

Beta-blockers are drugs that slow down certain cell activities. They are often used to treat high blood pressure. Taking beta-blockers for over six months may raise your risk of getting a pincer toenail. 

A pincer nail often develops slowly over time, and it may be challenging to recognize it at first. See your healthcare provider if you notice the sides of one of your toenails growing inward. When left untreated, a pincer nail continues to worsen.

See your provider right away if you’re experiencing toe pain or frequent infections. Your primary care provider will likely refer you to a podiatrist for treatment. 

Pincer toenails are treatable. Pincer toenail treatment aims to correct the curve and relieve symptoms like pain and swelling.

There is no standardized treatment plan for a pincer nail. Your healthcare provider will recommend treatment options based on your overall health and how advanced the pincer nail has become. If an underlying health condition is causing your symptoms, your provider will recommend treatment for the condition. 

Pincer toenail treatment can be challenging, especially if the nail is so curved that it is in a tube shape. Conservative procedures are less invasive options, but the condition may return. Surgical procedures are more effective but may require removing much of the toenail, which can be cosmetically displeasing for people. 

Conservative procedures to treat a pincer toenail include:

• Plastic device: The provider attaches a flexible, plastic material in an elliptical shape to the nail to correct the curve. 
• Shape-memory alloy: The provider places a nickel-titanium central rod and hooks over the nail. This treatment is used for more severe cases. 
• Nail grinding: This noninvasive technique thins the nail and makes it easier to straighten. 

Surgical procedures to treat a pincer toenail include:

• Wedge excision: The surgeon removes the area of the nail that is growing into the skin.
• Nail bed ablation: The surgeon removes part of the toenail and applies a chemical to prevent recurrence.
• Nail avulsion: The surgeon removes the entire nail. 

Preventing a pincer toenail may not always be possible, but you can take steps to lower your risk. Choose comfortable shoes that allow your toes room to move. Avoid high heels or shoes with pointed toes.

If you have been diagnosed with a chronic health condition associated with pincer toenails, discuss a treatment plan with your healthcare team. A pincer toenail will usually go away once the underlying condition is managed. 

The most common complication of a pincer toenail is infection.

When the ingrown nail breaks the skin, bacteria and other microorganisms can enter the cut, leading to an infection. People with a pincer toenail may experience nail or skin infections in the affected toe. Possible signs of an infection include redness, swelling, pus, and a fever. 

A pincer toenail occurs when the sides of the toenail grow inward toward the skin, causing pain, redness, and inflammation. People with a pincer toenail are at an increased risk of infection. 

Common causes of a pincer toenail include tight shoes, certain chronic health conditions, and taking beta-blocker medications. Pincer toenails usually develop slowly over years. There are several treatment options available, including both conservative and surgical procedures.