According to irregular changes in rail profiles in a fixed-nose crossing, a parametric design method was proposed based on the B-spline theory by considering the section characteristics of rail profiles in a fixed-nose crossing. In addition, the rail profile fitting evaluation indexes and the influence weights of key control parameters on the rail profile fitting were proposed. With No.12 turnout of fixed-nose crossing of 60 kg/m rail as an example, the design of experiment (DOE) was employed to analyze the influence of railhead slope, rail side slope, and proportion coefficient of composite circular arc on the changes in the full railhead profile, rail top profile, and rail side profile of the nose rail. The results show that 1) for nose rail with a section of 20 mm, the influence weights of railhead slope, rail side slope, and proportion coefficient of composite circular arc on the full railhead profile change are 21.08%, 56.89%, and 22.02%, respectively, and the influence weights on the rail top profile change of the nose rail are 8.42%, 61.95%, and 29.63%, respectively. For nose rail with a section of 50 mm, the influence weights of the key control parameters on the full railhead profile change are 55.9%, 33.38%, and 10.72%, respectively. For nose rails with a section of 20 mm and 50 mm, the influence weights of the rail side slope on the rail side profile change are 76.82% and 66.04%, respectively. 2) When the nose railhead width is 20 mm, the influence of the rail side slope on the nose profiles is more than 50%. As the nose railhead width increases, the influence weight of railhead slope on full railhead profile gradually increases from 21.8% to 55.9%, while that of rail side profile and proportion coefficient of composite circular arc is reduced by 41.3% and 51.3%, respectively.