Toenail Fungus vs. Ingrown Toenail: How to Tell the Difference and What to Do

By Dr. Christopher R.D. Menke, DPM, FACFAS — Double Board-Certified Foot & Ankle Surgeon, Founder of 26 Apothecary

Toenail Fungus vs. Ingrown Toenail: How to Tell the Difference and What to Do

Two or three times a week someone sits across from me in the exam room and describes a nail problem they have been managing the wrong way for months. The most common mix-up is toenail fungus being treated as a cosmetic issue and an ingrown toenail being treated as a fungal infection. Getting the diagnosis right matters because the treatment is completely different.

Dr. Christopher R.D. Menke, DPM, FACFAS — double board-certified in foot surgery and rearfoot and ankle reconstruction, founder of 26 Apothecary — walks through the clinical differences between these two conditions and what conservative care looks like for each.

What Is Toenail Fungus?

Onychomycosis is a fungal infection of the nail plate and nail bed, most commonly caused by dermatophytes — a class of fungi that thrive in warm, moist environments. The hallmarks are nail discoloration, nail thickening, nail brittleness, subungual debris, and in advanced cases, nail plate distortion. Onychomycosis is not typically painful in isolation — one of the ways to distinguish it from an ingrown toenail.

What Is an Ingrown Toenail?

Onychocryptosis occurs when the lateral edge of the toenail grows into or is compressed against the adjacent soft tissue of the nail fold. Unlike fungal nails, ingrown toenails are painful by definition, and the pain is localized precisely to the nail-tissue interface where the embedding is occurring.

Can You Have Both at the Same Time?

Yes — and this co-presentation is common. A nail with onychomycosis is thickened, brittle, and more likely to develop irregular lateral edges that embed into surrounding tissue. When both are present, both need to be addressed — treating only one typically results in incomplete resolution and recurrence.

Key Differences at a Glance

Pain location: Ingrown toenail pain is at the nail-skin margin. Fungal nail pain, when present, is more diffuse and related to nail thickness pressing on footwear.

Nail appearance: Fungal nails are discolored, thickened, and brittle. Ingrown toenails may look structurally normal — the only abnormality being the lateral embedding and surrounding tissue response.

Skin changes: An ingrown toenail produces localized redness, swelling, and often hypergranulation. Fungal infection does not produce acute skin changes unless secondary infection has developed.

Symptoms at rest: Ingrown toenail pain is often present at rest. Fungal nail discomfort is primarily shoe-related.

Conservative Management Considerations

For onychomycosis: topical antifungal preparations applied consistently, footwear hygiene, and avoiding barefoot exposure in shared moist environments. For ingrown toenails in the early, non-infected stage: footwear modification, proper trimming technique, and warm water soaks. Once infection is present, in-office management by a podiatrist is the appropriate next step.

When to See a Foot and Ankle Specialist

• Any ingrown toenail showing signs of infection — drainage, increasing warmth, spreading redness
• Onychomycosis present for more than 12 months without clearance on topical treatment
• Any nail concern in a person with diabetes, peripheral artery disease, or immunocompromised status
• Uncertainty about which condition is present

Frequently Asked Questions

Can I use over-the-counter antifungal products for toenail fungus?

OTC topical antifungals are appropriate for early, mild onychomycosis without nail matrix involvement, requiring consistent daily application over 6 to 12 months. For moderate to severe involvement, prescription or laser treatment produces significantly better outcomes.

Is toenail fungus contagious?

Yes — dermatophytes spread through contact with contaminated surfaces and direct skin-to-skin contact. Wearing protective footwear in shared moist environments and keeping feet clean and dry significantly reduces risk.

Will an ingrown toenail resolve on its own?

Most established ingrown toenails — particularly those with tissue hypertrophy at the nail margin — do not resolve without in-office treatment. Attempting to cut out the offending nail corner at home typically worsens the problem.

Does nail polish cause or worsen toenail fungus?

Nail polish does not cause onychomycosis, but it can impede topical antifungal penetration and mask changes in nail color. People undergoing topical antifungal treatment are generally advised to leave nails unpolished during the treatment period.

About the Author

Dr. Christopher R.D. Menke, DPM, FACFAS is a double board-certified foot and ankle surgeon — board-certified in both foot surgery and rearfoot and ankle reconstruction. He completed his podiatric medical training at Temple University School of Podiatric Medicine in 2005 and his residency at Northlake Medical Center and DeKalb Medical in Georgia, completing in 2008. He is the founder of 26 Foot and Ankle and 26 Apothecary, and the founder of Surgeons of Service, a Georgia-based humanitarian surgical nonprofit. Every product in the 26 Apothecary catalog was selected through the same clinical lens Dr. Menke applies in the exam room and the operating room.