Ingrown Toenails & Nail Surgery

Ingrown toenails and minor surgery

The term “ingrown toenail” is often used to describe a number of problems that lead to pain and discomfort around the nails despite the fact that in many cases the nail does not actually “grow” into the skin around it. Ingrown toenails may present in patients of all ages, but they have been reported to occur more frequently in young people.

Usually the medial or lateral side of the nail irritates or penetrates the skin creating pain, swelling and redness, an infection can easily develop. The great toe is most commonly involved, but they may also occur on multiple toes, or on both sides of the same nail.

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what causes pain around the nails?

  • Improper cutting
    A true ingrown toenail (onychocryptosis) is where a small nail spike pierces the skin leading to pain and infection. This normally occurs at the tip of the nail along the sides when a spike in the nail is left from improper nail cutting techniques or trauma. Nails should only ever be cut down the side by a professional.
  • Poor fitting footwear
    Tight shoes restrict room for nail growth and can cause micro trauma which can lead to ingrown nails.
  • Involuted/Incurvated nails
    Sometimes nail edges curve into the skin either due to trauma, changes in the bone under the nail or a congenital disorders.
  • “Chubby toes”
    People with chubby toes will find the skin at the sides of the toe, is more likely to be traumatized or pierced by the nail as it grows.
  • Flat feet
    Flat feet can lead to feet turning outwards when walking causing the weight of the body to “roll over the side of the big toe instead of propulsing straight over the top. This can lead to compression of the toes and can lead to an ingrown toe nail.
  • Corns, calluses and dry skin
    When found down the sides of the nail, these can lead to extra pressure in the nail sulcus.
  • Genetics
    Sometimes the shape of the nails that we have inherited from our parents can put us at a higher risk of developing ingrown toenails.
  • Trauma
    An acute injury near the nail or anything that causes the nail to be damaged repetitively (such as playing soccer) can also cause an ingrown nail. Common traumas include: once off occurrences such as dropping a brick on your toe; or continual micro trauma such as lots of little knocks from activities such as running, sports or wearing pointy toed shoes.

how are ingrown toenails treated?

Ingrown toenails can be treated two ways – conservatively or with surgery.

1) conservative treatment

  • Cutting techniques
    With a simple nail surgery designed to permanently remove the small side of the nail that digs in. If your nail is sore enough for you to be researching it, it should be checked by a podiatrist at the footinjuryclinic.
  • Soaking in salt water
    While soaking won’t cure ingrown nails, they are often recommended as the first step for newly infected nails before antibiotics can be obtained. Soak your foot in a salt water foot bath (1-3 tablespoons of salt in a liter of luke warm water) for 10 mins and follow by dressing with antiseptic (eg. Betadine) and a bandage until you can get some professional help.
  • Relieving the pressure off the area
    This can achieved by wearing less pointy shoes or using padding’s to deflect pressure away from the area of pain such as toe spacers.
  • Antibiotics
    Antibiotics are important if your nail is infected, however, antibiotics rarely solve the problem alone. Whist the toe may often seem to improve while on the antibiotics, the infection often returns once the course is finished, especially if there is a nail spike piercing the flesh.
  • Lifting up the corner of the nail that is digging into the skin
    This is done by taking a small piece of cotton or gauze and rolling it to form a small roll or wick. It is then placed between the nail and the skin to keep it elevated to relieve pain and pressure.
  • Eliminating the cause of the problem
    If it is caused by shoe wear for example, either reduce the time spent in those shoes or look at ways to take the pressure off the area with in shoe padding. If the problem is a genetically inherited one affecting the shape of the nail, then nail surgery may be needed.

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complications of treatment

  • Cellulitis
    Whilst reactive cellulitis (redness in the immediate surrounding area) is quite common, in some cases, the infection can spread and you may see the redness traveling up the foot or possibly up the leg. This must be treated as soon as possible.
  • Ulceration
    Complication in the infection site may lead to ulceration. In these cases the person must be seen to immediately.
  • Granulation tissue
    Ingrown Toenails Bondi JunctionSometimes ingrown toe nails have a bright red growth coming out of the side of the nail. This is known as a granulation tissue which is an accumulation of tissue such as blood cells, bacteria and scar tissue in response to trauma and infection. In isolation it may not prove to be serious however, it can be quite painful and tends to bleed a lot if traumatized leading to continuous cycles of infection and swelling. When the ingrown nail is removed or resected by a podiatrist it usually resolves on its own with the help of silver nitrate which is painlessly applied at the time of resection.
  • Cellulitis
    Whilst reactive cellulitis (redness in the immediate surrounding area) is quite common, in some cases, the infection can spread and you may see the redness traveling up the foot or possibly up the leg. This must be treated as soon as possible.

2) surgery

If ingrown toenails are a recurring problem, it is generally recommend that a podiatrist performs an in office procedure whereby the offending piece of nail is removed either on a permanent or temporary basis.

  • Nail wedge resection/ Partial Nail Avulsion. Most podiatrists prefer to do a simple nail wedge resection and matrix sterilisation with phenol. This procedure is done under local anaesthesia in the clinic. After the ingrown nail is removed, the growth plate (matrix) is neutralised using the repeated application of phenol, a strong alkaline designed to stop the nail growing back. After the local is applied, it is often a fairly pain free experience with most people reporting little to no pain after the procedure and being able to walk freely.

Minor surgery such as Partial Nail Avulsion and Nail Wedge Excision provide approximately 95% success rate in permanently curing ingrown toenails. They allow a quick recovery with a return to normal activities on the same day and minimal post-operative discomfort.

Patients are advised to attend a follow up dressing change 2 days after the procedure and are required to be seen again 1 week later to assess the progress of the nail and the surrounding tissue.

Nail pain affecting you? Book now and a quick and simple surgery can save you from pain.