Shoes for Ingrown Toenails: Toe Box, Height Over the Toes and Shoes After Surgery

An ingrown toenail usually affects the big toe, and footwear is among the main reasons it keeps coming back. A tight or shallow toe box pushes the soft tissue against the edge of the nail with every step. A pair that gives the toes enough room in width and height takes that pressure away. The nail itself is treated by a doctor or podiatrist; the job of the shoe is to stop injuring it.

This article is for general information. The workshop does not diagnose or replace a doctor: diagnosis, treatment and any correction are decided by a medical specialist. Bespoke shoes are made to follow a doctor’s recommendations.

What an ingrown toenail is

The medical term is onychocryptosis. The edge of the nail plate cuts into the nail fold, the skin around the nail, and causes inflammation: redness, swelling, pain on pressure and sometimes infection.

A 2019 review in American Family Physician gives a sense of scale: roughly one in five primary care visits for foot problems concerns an ingrown toenail. It is more common in young men.

The same review names footwear and nail care habits as the most frequent contributing factors. That is why talking about shoes is part of the treatment a doctor prescribes, not a separate topic.

Why shoes press on the nail edge

With every step the foot slides slightly forward and the big toe meets the toe box. If the toe box is narrow, its sides press the skin of the toe against the edge of the nail. If it is shallow, the upper presses from above and bends the nail down.

One step like that does little, but a day holds thousands of them. The skin at the nail edge becomes inflamed and swollen and starts to creep over the plate by itself, which closes the circle.

A pointed toe is especially risky: the taper starts early, and the big toe ends up in the narrowest part of the last. Dress shoes, narrow boots and trainers bought a size too small are frequent companions of an ingrown nail.

Other causes worth knowing about

A 2009 review in the same journal lists, besides footwear, improper nail trimming, repeated and accidental trauma, a hereditary nail shape, excessive sweating and poor foot hygiene.

When a nail is cut in a curve and too short, the corner of the plate grows under the skin, and the shoe only finishes the job. This is why doctors advise cutting the nail straight across, leaving the edge slightly longer than the skin.

Sweating softens the skin and makes it easier for the plate to cut in. Breathable materials help here: a leather lining and a leather insole instead of synthetics.

How much room the toes need

In length, about a centimetre is left in front of the big toe. Less, and the toe hits the front of the shoe; more, and the foot slides forward so the toe still takes the impact.

In width, the toe box should follow the outline of the toes without squeezing the big toe from the side. On a ready-made last this is rare: width is added across the ball of the foot while the toe box stays narrow.

In height, a few millimetres of clearance are needed above the nail. Toe height is measured separately at the fitting, because people with thick or curved nails need more than usual.

Which toe shape to choose

A round or square toe leaves room both in width and in height. For men’s classic shoes that means derbies and oxfords on a last with a generous toe box; for women, loafers, ankle boots and shoes with a soft toe.

The toe puff, the stiffener that holds the shape of the toe, has to sit above the nail. If it is too low, it presses on the nail constantly, even when the length is right.

A soft toe puff, or none at all, suits house and summer shoes. A street pair needs one so the toe does not sag and press on the toe after a couple of months of wear.

A fastening keeps the foot in place

When the foot moves inside the shoe, the big toe knocks against the toe box. With an ingrown nail, styles with laces, a strap or a buckle work better: they hold the foot at the instep.

Slip-ons and pumps stay on only through an exact fit. If the pair is slightly loose, the foot slides forward and the toe takes a knock with every step, especially going downhill or down the stairs.

A firm heel counter serves the same purpose: it holds the heel so the foot does not shift forward.

Heels and going downstairs

The higher the heel, the more the foot slides toward the toe and the greater the load on the toes. When the nail edge is inflamed, a heel above three to four centimetres usually becomes painful.

Going down stairs or downhill loads the toe box too. In a shoe that holds the instep well the toe stays in place; in a loose one it is driven into the front of the shoe.

If you cannot do without a heel, it is made stable, and the last is built with extra height over the toes and a firm hold at the instep.

Shoes after the nail edge is removed

When an ingrown nail keeps recurring, doctors remove the edge of the plate, often together with part of the growth zone, the matrix. This is called a matricectomy and it is done surgically or chemically.

A 2025 retrospective study looked at 300 such procedures in 164 patients. The authors found no statistically significant difference in recurrence, complications or satisfaction between the surgical and chemical methods.

After the procedure the toe is bandaged and will not fit into an ordinary shoe. For the first days people wear open shoes or a post-operative shoe prescribed by the doctor, who also decides when to move back to a closed pair.

Going back to closed shoes

Once the wound has healed and the dressing is off, closed shoes are possible again. For a while the toe stays sensitive, and even a familiar pair may press on the healed edge.

If the ingrown nail was caused by tight shoes, going back to them after surgery means risking a recurrence. Review the pairs you wear most: length, toe box width, height over the toes.

For the first weeks a pair with a soft upper over the toes and a roomy toe box is best. If you have no such pair, it is worth choosing or ordering one before the wound has fully healed.

Sport and ingrown toenails

Running, football, tennis, hill walking: anything where the foot brakes sharply or walks downhill for a long time knocks the toe against the toe box. Athletes often buy shoes that fit tightly, and the nail suffers first.

For sport the same length allowance applies, about a centimetre, and the laces are tied so the foot does not slide forward. The toe box of a trainer should be deep and soft over the toes.

If the ingrown nail is linked to sport, check your socks as well as your shoes: tight socks press on the toe just as a tight toe box does.

Thick and curved nails

With age, after injury or with a fungal infection, the big toenail thickens and its edges curl down like a gutter. Such a nail ingrows more easily and needs more room above it.

A standard toe puff is designed for a thin nail. A thick plate meets it with every step, a bruise appears under the nail, and the edges press on the nail folds even harder.

At the fitting the height of the toe with the nail is measured separately on the right and left foot. The toe puff is raised exactly as much as needed, so the toe of the shoe does not look bulky from the outside.

A thickened nail is treated by a doctor or podiatrist. If it is thinned, the measurements are taken again afterwards.

Winter shoes and ingrown toenails

In winter the problem gets worse: a thick sock and fur lining take up the room over the toes, and the usual size becomes tight at the toe. That is why an off-the-shelf winter pair often presses on the nail more than a summer one.

For a winter pair the last is built with the thickness of the fur and sock in mind. The fur compacts in the first weeks, but over the toes it is left thinner so the toe box does not press from above from the first day.

Laced winter boots hold the foot at the instep on a slippery pavement too. When you brake on ice, a foot in a loose pair drives the toe into the front of the shoe harder than in summer.

Why ready-made shoes do not always fit

Mass-produced lasts are made for an average foot. For someone with broad toes or a tall big toe, the toe box of almost any fashionable pair turns out to be tight.

Buying a size up is a common answer that does not help. The length grows, but the toe box keeps the same shape: the toe still meets the taper, and now the foot also slides around inside.

Stretching in a workshop can widen soft leather at the toe a little, but the toe puff and the shape of the last stay the same.

How the last is built for an ingrown nail

Sergey Grechushkin makes the lasts himself, from measurements of both feet. With an ingrown nail the height of the big toe with its nail and the width of the toes at their widest point are recorded separately.

The toe of the last follows the outline of the toes, and the toe puff sits above the nail. If the toes of the right and left foot differ, the lasts are made differently, while the pair still looks symmetrical from the outside.

The fit is checked on a trial shoe, a fitting mock-up. At the fitting the shoemaker watches whether the toe box presses on the big toe while walking and going downhill, and corrects the last before the real pair is made.

The lasts stay at the workshop. When you need a second pair, for winter or summer, it is made on the same last with the same toe shape, without new measurements.

Timing and cost

The lasts take about six weeks, and the first pair is ready in about ten weeks including the fitting. Repeat pairs on an existing last take from four weeks.

A pair costs from 100,000 ₽. The price includes measuring, the lasts, the trial shoe and making the pair.

If you have just had nail surgery, the measuring is planned after healing. Your doctor will tell you when the swelling has gone down and the toe is back to its normal volume.

The workshop is at Shelaputinsky Lane 6/3 near Taganskaya metro in Moscow and works from 10:00 to 20:00 strictly by appointment, made by phone or through a messenger.

When to see a doctor or podiatrist

Redness and swelling at the nail edge, pain on pressure, pus, bleeding overgrown tissue or the problem returning on the same toe are reasons to see a doctor or podiatrist.

With diabetes or poor circulation in the legs, an ingrown nail should be treated only by a specialist: even minor inflammation on such a foot is dangerous.

The shoemaker does not treat the nail or open an infection. The workshop’s job is to make shoes that do not press on the toe while the doctor handles the treatment.

Care and prevention

Cut the nail straight across, leaving the edge level with the tip of the toe. Do not round the corners or cut them deep.

Change shoes during the day if you walk a lot. Choose socks in your size, without a tight band around the toes.

Once a season, check whether the toe of your favourite pair has sagged. A collapsed toe puff presses on the nail just like a narrow style, and it can be restored in a workshop.

Look at your toes after a long walk. Redness at the nail edge on the very first evening shows which pair is pressing, and it is worth setting that pair aside until a shoemaker has checked it.