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Ingrown toenails

Ingrown toenails occur when the nail penetrates the skin at the side of the nail plate (sulcus). This causes a wound (or foreign body reaction) that can become infected. In some instances this results in extra tissue forming (hyper granulation tissue). This tissue has a very good blood supply and can bleed easily.

What causes ingrown toenails?

Often, they are due to the shape of the nail plate. Some people have wide nail plates, others curved nail plates which means the nail cannot easily grow free at the sides. This makes cutting the sides of the nail very difficult and often results in the nail being pulled at this point. If a spike of nail is left or causes a small tear in the skin, a wound is formed and infection can follow.

Trauma to the nail plate or swelling of the surrounding skin can also cause an infection and therefore IGTN.

Will it get worse?

The infection and swelling generally gets worse if untreated.

What are the common symptoms?

Pain
Swelling
Bleeding / weeping
Foul odour
Difficulty in shoes
Difficulty walking

How is it recognised?

This is easily diagnosed on clinical examination.

What can I do to reduce the pain?

There are several things that you can do to try and relieve your symptoms:

Wear good fitting shoes
Take care with nail cutting
Bathe the foot in warm, salt water daily
Keep the toe covered with a clean / sterile dressing
Have a course of antibiotics from your GP
See a podiatrist

What will a podiatrist do?

If the simple measures above do not reduce your symptoms, there are other options:

Remove a small section of nail
Advise on surgery

Will this cure the problem?

Simple measures / palliative treatment may be all that is required.

What will happen if I leave this alone?

It is likely to get worse.

How can I cure the deformity?

For more severe or recurrent cases, surgery is required.

How does the operation correct the deformity?

There are two types of operation:

Partial nail removal (avulsion) with destruction of the nail bed / root
Surgical excision (Winograd)

The most common procedure is removal of the side of the nail. Whilst this alone will resolve the infection, the nail will regrow and possibly cause the same problem. Destruction of the nail bed and root (matrix) prevents re-growth. This is usually achieved by using a chemical (phenol) although this can be achieved via an electric current.

This is a highly successful operation.

In some instances, surgical excision of the side of the nail plate, bed and root are necessary. This is also very successful.

I have heard it is very painful

The partial nail avulsion using chemical ablation (destruction) rarely causes any significant discomfort. There is slightly more discomfort with surgical excision, although this is generally only mild to moderate.

Will I have to have a general anaesthetic (be asleep)?

Not if you did not want one. Many of these procedures are performed perfectly safely under local anaesthetic (you are awake). Some patients worry that they may feel pain during the operation but it would not be possible to perform the operation if this were the case.

Will I have to stay in hospital?

No. As long as you were medically fit and have adequate home support, many patients are able to have this type of operation performed as day surgery and go home.

Are there a lot of complications?

There are risks and complicationswith all operations and these should be discussed in detail with your specialist. However, this operation has a very low complication rate. A thorough examination of your foot and general health is important so that these complications can be minimised.

Although every effort is made to reduce complications, these can occur. In addition to the general complications that can occur with foot surgery, there are some specific risks with ingrown toenail surgery:

Nail re-growth (low at 5-8%)
Inclusion cyst
Reaction to the chemical

When will I be able to walk again and wear shoes?

For the partial nail avulsion using chemical ablation, you can walk immediately after the operation, although it is generally best to rest that night. You will need to bathe the foot in warm salt water for 15 minutes, twice daily and redress the toe until it has healed. This is generally between 2-4 weeks due to the chemical burn but it is not usually painful during this period.

For the surgical excision procedure you will need to rest your foot for 2-3 days and sutures (stitches) are removed at two weeks.

When will I be able to drive again?

When you feel able to perform an emergency stop. This is usually the next day for the chemical procedure and up to two weeks post operatively for the surgical excision but you should always check with your insurance company first.