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CURRENT CONDITION UPDATE

Ingrown toenails

This is where the toenail has curled and grown into the skin surrounding the side of the toe. The great toe is the most affected toe and it can occur on either side of the toenail.

Why did I get an ingrown toenail?

There are many contributing causes:

  • Badly cut nails – toenails cut short and round are more prone to ingrowing. Toenails should be cut square and not too short.
  • Tight fitting shoes or socks/stockings/tights – puts pressure on the skin fold
  • Sweaty feet – make the skin softer and therefore makes it easier for the toenail to pierce the skin
  • Injury
  • Fungal infection – leads to nail thickening
  • Naturally curved or fan shaped toenails

Prevention of ingrown toenails involves attending to all the above.

What symptoms might I get?

Ingrown toenails may become swollen, tender and red. Bacteria then get in and pus might then build up or be released from between the nail and the skin fold of the side of the nail.

How are ingrown toenails treated?

  • Soaking in salty baths gives relief
  • Antibiotics if infected
  • See a podiatrist for regular check ups and foot cares – if you have foot problems or other medical problems (eg: diabetes) that alter the feeling in your feet or if you can’t see or reach your toes to attend to them.

What does wedge excision for ingrown toenails involve?

  • You may need either an injection at the base of your toe or some people may need or prefer to have a general anaesthetic for the procedure
  • The nail and the overgrown skin fold are cut all the way to the base of the nail, a special chemical called phenol is applied to prevent regrowth and the toe is dressed
  • You will be able to come in on the day of surgery and go home on the same day
  • You may be discharged on antibiotics and pain relief – once the local anaesthetic wears off you will have pain
  • You will need a first dressing change at 48hours
  • Wear soft or open toe shoes
  • You will need to keep the toe dry (shower with plastic bag over the foot, no swimming) until it heals – at least 2 weeks
  • It will take 6-12weeks to heal completely
  • The nail that grows in future will be narrower
  • You will need to rest and elevate the foot for 2 weeks (you can still walk gently around the house
  • Complications include: cosmetic problems with the nail, recurrence of the problem.

When do I need complete removal of the toenail and what does that involve?

  • If you are having recurrent problems after attempts at wedge excision or if the whole nail is thick and problematic
  • The treatment is similar to having a wedge removal of the nail except that in this instance the whole nail is removed
  • The nail does not grow back and it is perfectly safe not to have a toenail
  • Some people choose to use nail varnish so that the appearance of the absent nail is not so obvious

How effective is surgery?

  • Surgery combined with preventative strategies (good footwear, proper nail cutting technique, clean feet, regular podiatry care if you have other medical problems or cant’s see or reach your toes) is 70-95% successful at preventing recurrence.