This is a common foot related problem and usually affects the big toe on one or both sides, although other toes can be affected too.
An ingrown toenail develops when the sides of the toenail pierces the flesh of the toe. This can become extremely painful, inflamed or infected and can cause pus, bleeding and an overgrowth of skin around the affected toe.
If left untreated the infection can spread to the rest of the toe and foot. It is best to seek advice from a podiatrist to treat these quickly and prevent worsening.
What Are The Causes of Ingrown Toenails?
- badly cut toenails – cutting your toenails too short, cutting the corners, or tearing off the nail instead of cutting will encourage the skin to fold over your nail and the nail to grow into the skin
- wearing tight-fitting shoes, socks or tights – this places pressure on the skin around your toenail and the skin may be pierced if it’s pressed against your toenail
- injury – for example, stubbing your toe can sometimes cause an ingrown toenail to develop
- natural shape of the nail – the sides of curved (involuted) toenails are more likely to press into the skin surrounding the nail
- fungal nail infection – can cause your toenails to thicken or widen
How Do You Treat Ingrown Toenails?
Without treatment an ingrown toenail can worsen and become infected, so it is advisable to see a podiatrist for assessment and advice. They may be able to remove any nail spikes and cut the nail into a better shape. You can help by:
- keeping your feet clean, washed regularly and dried carefully
- change your socks regularly
- cutting your toenails straight across the top (not too short) and filing the edges slightly rounded
- gently pushing away the skin at the sides of the nail using a cotton bud (this may be easier after using a small amount of olive oil to soften the skin)
- wear comfortable shoes that fit properly
Surgery may be recommended if your toenail and any symptoms don’t improve. This can be quickly done under local anaesthetic by a podiatrist, and may involve either:
- partial nail avulsion (PNA) – removing just the side/s of your toenail leaving a central portion of nail
- total nail avulsion (TNA) – removing your whole toenail
- chemical matrixectomy – may or may not be undertaken with either of the above 2 procedures, depending on whether you want to prevent the nail from re-growing after the nail removal. A chemical (usually phenol) can be used to damage the matrix which consists of specialised cells that produce the nail plate. Whether a matrixectomy is advisable or not depends on the cause of an ingrown toenail and will be fully discussed by your podiatrist.
Your podiatrist will fully explain the nail surgery procedure, risks/benefits and after care. The whole appointment will take about 45 minutes.
You will need an injection of local anaesthetic to each side of the base of toe. For some people this is a little uncomfortable but once the anaesthetic is injected and taken effect, you will not feel any pain. Rest assured that the procedure will not continue until the podiatrist has made sure that the toe is adequately numb.
The actual removal of the nail is very quick after which the chemical will be applied if you do not want the nail to grow back, and then the toe covered with a dressing.
You should bring open toed shoes or a loose slipper to go home in and it is strongly advised that you do not drive home as your toe will still be numb. Doing so may invalidate your car insurance.
After a few hours the anaesthetic will start to wear off and some people may want to take some simple analgesia if they feel any discomfort. Aspirin based products should be avoided as these can promote bleeding.
What Happens After Surgery?
You will be given a follow up appointment and advised about after care and dressing changes.
You will need to keep the dressings on until the wound is dry and fully healed. Healing time varies but should be between 6-12 weeks depending on factors such as medical history, medications, style of footwear and activity undertaken.
You may be able to go to work/school the following day as long as you can wear roomy shoes to accommodate the dressing and you aren’t at risk of injury or activity that may aggravate the wound. Pressure and damage to the wound is likely to delay healing.
Your podiatrist will be able to advise you when you can resume sporting activities.
The Main Risks & Benefits of Nail Surgery
Nail surgery is regarded as a minor procedure, but as with any procedure there may be some risks. In some cases it may advised that you have the procedure at a hospital rather than in a clinic.
| BENEFITS | RISKS |
| Relief of painful condition | Possible discomfort after the anaesthetic wears off |
| Resolution of a recurrent problem | Possible irritation of skin due to the chemical used to destroy the nail bed |
| Removes cause of infection and need for repeated antibiotics | Risk of allergic reaction to the anaesthetic – procedures will be in place to manage this |
| Use of a local anaesthetic so fasting is not required | Nail bed and surrounding tissue may become infected |
| A quick procedure | Total nail removal may not be cosmetically acceptable and partial nail removal may leave permanent deformity of the remaining nail |
| Minimal time off school/work (depending on activity) | 5% chance of nail regrowth despite use of the chemical |
| Partial removal of nail is cosmetically acceptable | Damage to nerves and blood flow
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