An ingrowing toenail is one that pierces the flesh of the toe. It can often be a splinter of nail digging into the flesh, and can be extremely painful.
Ingrowing toenails are commonly caused by the following:
- Incorrect nail cutting. When cutting your nails avoid cutting straight across. Always trim following the natural curvature of the nail plate and avoid “digging” down the sides of your nails.
- Tight footwear and hosiery.
- Direct trauma.
- Underlying biomechanical condition.
In more severe cases, it can become infected, producing pus and bleed. Ingrowing toenails most commonly affect the large toenail, but can affect the other toes too.
A nail that is curling (involuted or convoluted) into the flesh, can also be very painful.
As the infected ingrowing nail is left for weeks to embed into the adjacent flesh, the surrounding skin starts to grow excessively both around and underneath the nail as it dissociates itself from normal skin forming excessive skin or hypergranulation tissue, with a well developed nerve and blood supply completely obscuring the ingrowing nail.
It is as this point that even the slightness tap to the toe can result in extreme pain and bleeding.
Patients are commonly prescribed repeated antibiotics (Flucloxacillin) to reduce infection and inflammation this serves no other purpose for the chronic condition which urgently requires a routine surgical procedure to remove the offending section of ingrown nail providing a permanent cure, known as a partial nail avulsion.
There are 3 common procedures we practice for performing ingrowing toenail surgery under local anaesthesia.
Partial nail avulsion
A partial nail avulsion involves removal of the offending nail section ONLY whilst maintaining the rest of the nail plate, the corresponding nail bed is cauterised with a chemical called phenol to prevent regrowth, complete healing is usually between 2 – 3 weeks and does not require time off school or work.
Total nail avulsion
A total nail avulsion involves the removal of the entire nail and cauterisation of the complete nail bed, complete healing is usually between 4 – 5 weeks and does not require time off school or work. This procedure is generally used for grossly thickened and fungal infected nails.
If your ingrowing nail presents with hypergranulation tissue, this is surgically removed prior to either a PNA or TNA procedure.
Winograd’s procedure
Involves surgically removing both the nail plate and the corresponding nail bed. Sutures hold the wound together whilst healing takes place. These are removed after 10 – 14 days. This procedure is generally used to promote rapid healing in those patients who present with a systemic health issue e.g Diabetes
What to expect after surgery
Most patients report very little or no pain after their operation, we advise that you take pain relief medication when you arrive home e.g Paracetamol.
Most patients report very little or no bleeding after their operation, those patients who have been prescribed Warfarin are advised to stop 24 hours prior to their procedure. As post – operative dressings are small in size, patients are able to return home in normal footwear, some patients prefer to bring an open toe sandal or slipper.
We advise that you rest with your operative foot elevated for a couple of hours when you return home. The local anaesthetic usually takes a couple of hours to wear off. Patients are advised not to bathe for 24 hours following their operation.
Patients require no time off work or school the following day after your procedure. Patients are seen for their first redressing appointment the following day, then advised how to dress their toe daily with sterile dressings that we provide, should patients encounter any post-operative problems a 24 hour Podiatry on call service is available.
Patients are seen weekly by the same Podiatrist until their wound is completely healed and then discharged.
Driving a motor vehicle
Most patients are able to drive the day after their operation, although we recommend when you feel comfortable and confident to perform an emergency stop in your vehicle.
Returning to sport
We advise that you wait until your wound is completely healed before returning to any sporting activity.
Time off work or school
As this is a minor procedure, patients can return the following day to work or school.
