Ingrown Toenails

An ingrown toe nail is a nail that curves into the skin. The medical term is onychocryptosis. It may or may not be painful, and may or may not cause infection. An ingrown nail that causes infection or inflammation is called a paronychia. Ingrown toenails that cause inflammation or infection are usually very painful.

Causes:

  • Trauma or any damage to the nail or the nail bed can result in ingrown nails.
  • Microtrauma: Repetitive pressure from shoes. Runners, tennis, rugby and football players commonly have ingrown toenails.
  • Blunt trauma: dropping something on your toe or kicking a chair.
  • Shoes: Especially narrow shoes which are too small, place pressure on the big toenail, resulting in repetitive microtrauma.
  • Fungal Nails: causes changes in shape of the nail and the nail bed, sometimes resulting in ingrown toenails.
  • Genetics: some people are born with nails which naturally turn in at the sides and typically develop ingrown nails very early in life.

Treatment

Conservative care VS Nail Surgery.

Conservative approaches to therapy are appropriate for initial management of ingrown toenail. This includes chiropody to try and take the pressure off the side of the skin by cutting down the side of the nail in a controlled way by your Podiatrist. When conservative therapy fails for initial management of ingrown toe nails, surgical treatment may be appropriate.

Nail Surgery

Indications for In-growing Toenail Surgery

  • Failure of conservative care to resolve the condition
  • Recurring in-growing nails
  • Painful involuted nails  (i.e. chronic curled-in nails).
  • Infected in-growing nails
  • Deformed nail shape
  • Thickened fungal nails which can cause pressure on the toe

So what do we do on the day of the procedure?

  1. The procedure entails local anesthetic being put either side of the big toe to make the toe go numb, so you won’t be able to feel anything
  2. The toe is then washed and an antiseptic is applied all over the area to prevent any infection
  3. The procedure differs slightly depending on the nail pathology, however it usually involves removing part, or all of the nail
  4. Once the offending nail is removed, a chemical called phenol is applied; this is what stops the nail from growing back
  5. The nail is then dressed with a bulky dressing to prevent any further trauma or infection
  6. We get you back the following day to redress the area
  7. We see you between 3-5 times after this to redress and check progress; you will be issued with all your dressings for this period and instructed on how to redress it yourself. Usually healing time is 3-6 weeks but some nails can take longer

Key Points

  • No skin is cut at all.
  • There will be NO regrowth of the nail.
  • Patients can go back to work the next day or even on the same day, depending on occupation.