Ingrown toenail

What is an ingrowing toenail?

An ingrown toenail is when the edge of the nail ‘grows’ into the skin at the edge of the nail.

This causes a skin infection which may bleed, discharge and overgrow. It is like having a splinter in the skin. The inflammation will not settle down until the bit of toenail in the skin is removed.

What are the symptoms?

Symptoms include pain and inflammation at the edge of the nail. This almost always happens on the big toes, but can also happen on other toes as well.

How is it diagnosed?

An ingrowing toenail is easily diagnosed by having your toe examined.

What can I do to avoid ingrowing toenails?

Avoid picking your nails.

Cut the toenails straight, (not curved like fingers) leaving them long. Make sure the nail is long enough to be past the skin fold.

Avoid wearing tight shoes or wearing closed footwear for long periods of time. Toe nails are more likely to stick into soft, warm, moist skin.

How can ingrown toenails be treated?

Sometimes the bit of nail causing the problem falls off by itself and the inflammation dies down.

If the toenail can be kept away from the skin then the inflammation does not develop. This will mean looking after your feet carefully and regularly if you are prone to ingrowing nails.

Follow the steps below:

• Soak the toe in warm water for 10 minutes to soften the nail and the skin
• Using a cotton wool bud, push the skin fold over the ingrown nail down and away from the nail. Do this starting at the root of the nail and move the cotton wool bud towards the end of the nail
• Repeat each day for a few weeks, allowing the nail to grow
• As the end of the nail grows forward, push a tiny piece of cotton wool under it to help the nail grow over the skin and not into it. Change the cotton wool daily.
• Do not cut the nail but allow it to grow forward until it is clear of the end of the skin. Then cut it straight across and not rounded at the end.

What about antibiotics?

These may help if there is a lot of infection in the skin, but they do not solve the underlying problem which will reoccur unless something is done to the nail.

What if the treatments do not work?

If the steps taken above have not worked or it is too painful to do them an operation may be the only way forward.

What does the operation involve?

We can remove part or all of the nail in an operation. This solves the problem immediately but the ingrowing nail can return in half of patients.

For this reason, we remove a section of the nail in the corner, and then use a chemical to treat the nail bed (where the nail grows) so that part of the nail does not regrow. Using this, the ingrowing nail will only reoccur after 1 in 10 operations.

The operation is called a ‘wedge resection’ (meaning the bit of nail taken out) and ‘phenolisation’ (the chemical used) of the nail bed.

Do I need to be asleep for the operation?

You can be asleep or awake for the operation.

We can numb the toe with cream, then anaesthetic injections. These may hurt a little when the injection is put in, but should not do so after this.

Or we can do the operation when you are asleep under general anaesthetic.

What are the risks of the operation?

The risk of the operation not working is about 1 in 10.

The chemical can damage the rest of the nail bed causing the nail to become ridged, uneven or thickened. Sometimes the whole nail may fall off.

The wound can also get infected like after any operation.

There may be a little bleeding but this usually settles.

What happens after the operation?

The toe will hurt after the local anaesthetic has worn off. It is helpful if you keep your foot raised, and taking regular pain relief such as paracetamol and ibuprofen.

There will be a dressing around your toe for the first 48 hours which will then need to be changed. It is usually enough to just use a dry dressing until the area heals and is fully dry. This usually takes 7 to 10 days.

You may not be able to wear normal foot wear for several days.

It is best to avoid sports until the toe is no longer painful to touch.

Are there any long term effects of ingrowing toenails?

Reoccurring ingrown toenails cause pain, swelling and risk of spreading infection.

If the operation is successful and you look after your toenails you should be able to avoid these.