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
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
What are the common symptoms?
- 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
- 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
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
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
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
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
- 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
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.
When will I be able to return to work?
The next day for the chemical procedure and dependent upon your
comfort levels for the surgical procedure (1-2 weeks).
When will I be able to return to sport?
You should be able to return to full sport as soon as the toe
has healed (2-4 weeks).