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Ingrowing toenails
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Ingrowing toenails are commonly seen in clinic they can be very painful and troublesome, they can present in a variety of ways depending upon severity, duration, and cause.  They can become infected with antibiotics required.
Common Causes

Tight Shoes 

Wearing shoes that are too narrow or short can put increased pressure onto the toes creating an ingrowing toenail. Commonly seen in ladies wearing high narrow shoes and footballers who like to have their boots fitting snugley.

Trauma/Injury

Dropping items, having your toe trodden and repetitive injuries such as kicking balls can lead for the nail to become inflamed and ingrowing.

Poor Nail Cutting

Cutting your nails to short or down the sides of the nail can cause injury and lead onto an ingrowing nail.

Nail Picking

picking nails is often a habit like biting your nails, this can cause damage to the nail plate.

Hereditary

We inherit the shape of our foot often from a parent or relative, this is also the case for nail plates as they often be wider and naturally have an increased curvature to them, creating a higher risk of experiencing and ingrowing toenail

Diagnosis
Diagnosis is predominantly clinical, occasionally a x-ray is required as small growth of bone (exostosis) from the end of the toe can also produce symptoms, this often gets missed.
Conservative Treatments
Many presenting ingrowing toenails can be prevented and treated conservatively often if caught early enough.  Conservative treatment may include removing a small wedge of nail and placing a piece of packing at the edge of the nail plate, to act as a buffer. Changing footwear to a wider and longer shoe can also help. If conservative treatments are unsuccessful nail surgery may be indicated.

 

Nail Surgery: (Partial nail avulsion with phenolisation of the nail matrix)

This is normally completed under a local anaesthetic, which involves two injections at the base of the toe. A partial nail avulsion is wear a section of nail is removed from the offending side of the toenail, to create an altered shape. A chemical called phenol is applied to where the nail has been removed to stop the in-growing toenail from reoccurring. The procedure takes approximately 10-15minutes, however please allow for up to 1hour for preparation and post operative monitoring.
Compressed ingrowing toenail
Considerations for Nail Surgery:
Every effort is made to reduce these, however, pertinent risks and complications include:

  • Infection (2-4%)
  • Recurrence and re-growth of the offending nail 5-8% and up to 10% undergoing total nail removal.
  • Delayed healing may occur which may be brought about by a chronic infection pre-op
  • A thickened nail plate
  • Altered nail shape, every effort is made to provide a cosmetic appearance, sometimes due to a large involuted plate or chronic infection a large section needs to be removed.
  • Post operatively:

    There maybe some mild pain and discomfort following the procedure for which it is advised you take some painkillers prior to the anaesthetic wearing off. It is important for you to go home and elevate your for and rest for 48hours after the procedure. Please bring a pair of wider fitting shoes or sandals as the initial dressing maybe bulky. You will be shown how to look after your toe, healing takes approximately 4-6weeks, for this duration is important to keep a dressing on your toe, it is quite normal for the surgery site to discharge whilst healing is occurring.

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