What is an ingrown toenail?
The corner of the toenail grows into the nearby tissue and causes inflammation and infection, swelling and pain. Usually the big toe is affected.
What is the cause of ingrown toenails?
The corner of the toenail does not project beyond the soft tissues. The corner then digs into the skin beside the toe. The corner is too far back either because it breaks off or is cut or trimmed back too far.
How can ingrown toenails be treated without an operation?
The two strategies are to encourage the toenail edge to grow out beyond the soft tissues, and to prevent and treat infection.
Toenail edge:
When trimming the toenail, cut it straight across.
Using a length of cotton or dental floss, hook the nail edge up and out of the soft tissue.
Preventing infection:
Avoid hot sweaty feet where bacteria like to proliferate.
Wear sandals or bare feet as much as feasible.
If wearing shoes, leather shoes ‘breath’ better than sandshoes.
Change socks regularly.
Wash feet 2-3 times a day – warm sitz baths can help – place a tablespoon of table salt in a washbasin of clean warm water and bathe the feet.
Treating infection:
Your doctor will advice on this. Antibiotics are often prescribed.
Why perform surgery for ingrown toenails?
If significant problems persist despite non-operative measures then surgery can often provide a cure. The usual operation is a ‘wedge resection’. The side of the toenail is removed and the base where the nail grows from, called the germinal matrix, is obliterated on the affected side to prevent the problem recurring.
How is the operation performed?
A general anaesthetic (going fully to sleep) is usually given for children. Local anaesthetic is also used to help relieve pain after the operation. In adults and some young people a local anaesthetic alone can be used.
A strip of nail is removed from the affected side. A cut (incision) may be made in the skin at the base of the nail to provide better access to the germinal matrix. An appropriate portion of the germinal matrix is excised and a solution may also be applied (eg phenol) to further help obliterate it. The incision is sutured closed and a bandage is applied.
What are the risks of the operation?
Infection: Preventative antibiotics may be given before, during or after the operation to prevent this.
Bleeding: A little oozing of blood after the operation is quite common.
Recurrence: If the germinal matrix is not adequately removed, some toenail may grow back into the corner and the problems may recur.
What are the benefits of surgery?
The recurrent infection and pain may be cured.
What to expect after the operation?
After the local anaesthetic wears off the toe may be quite painful (see post-operative instructions).
A week of rest will be required, and 2-3 weeks off sport.
The operation site will look somewhat ‘raw’ after the dressing is taken off.
A suture may need to be removed between 1 and 2 weeks after the operation.
The toenail will narrower than before the operation.
A ‘crust’ may form over the exposed nail bed where the side of the toenail has been removed.
