Ingrown toenails

Welcome to our comprehensive guide to ingrowing toenails. On this page we will give you essential information on ingrowing toenails, including the causes, signs, symptoms, and most importantly how to treat them. Below are some photos of different types of ingrowing nails as well as extensive videos from our YouTube channel, where I not only show you how the procedures are carried out, but explain and illustrate them to you.

What are Ingrowing Toenails?

Ingrown toenails affect up to 5% of the population. They are a painful development on the toes where part of the nail cuts or pierces the adjoining skin. This causes pain, swelling, and if left untreated can lead to infection requiring antibiotic therapy. They usually affect the big toes and are mostly caused because of tight fitting shoes, hyperhidrosis (excess sweating), malcutting of the nails, genetics or trauma. Different treatment options are available depending on the severity and suitability of the patient. Some of these options are detailed further down the page.

The above photos show an ingrown toenail caused by a spike of nail, which was carefully removed and treated after a local anaesthetic injection to the toe.

If you would like to see more of the above, watch the two part series of videos on my YouTube channel below.

Common Symptoms of Ingrowing Toenails

1. Pain - You will usually develop pain or discomfort along the sides of of the nail or at the corners at the tip of the toe. This can make it more difficult to walk and wear shoes.

2. Swelling - The surrounding skin may become red, swollen and tender.

3. Infection - typical signs of infection are pain, reddening, swelling, increased heat, pus, and malodour.

If you have the above signs, you likely have an ingrown toenail and should check your toe with a podiatrist. The above procedure of removing a spike of nail would be categorised as a conservative nail treatment under local anaesthesia. This is suitable in some cases but more often, and certainly with more severe cases, a partial nail avulsion procedure is required.

What is a Partial Nail Avulsion?

A partial nail avulsion procedure is the most common treatment for ingrown toenails. It involves cutting back the full length of your nail on one side after a local anaesthetic injection. Afterwards a chemical (phenol) is applied to the root to stop this section of nail growing back again. The nail is then permanently slightly narrower to prevent recurrence.

Explanation of ingrown toenail treatment

To find out more about this procedure, watch the videos below. They explain and illustrate a partial nail avulsion procedure, and a total nail avulsion procedure in detail.

Ingrown Toenails on Smaller Toes

Although it is most common to develop an ingrown toenail on one of the big toes, sometimes the smaller toes can become affected. Below are two videos on fixing an ingrown toenail on a 4th toe. The first video shows the procedure in detail and the second video is a detailed walk through of the procedure.

Severe Cases of Ingrown Toenails

In severe cases of ingrown toenails, hypergranulation tissue can develop. This is bright red soft tissue that easily bleeds, and it develops as a foreign body tissue reaction to the nail. Below is an example of a chronic ingrown toenail with severe hypergranulation tissue - before, during, and one month after the procedure. The procedure involved a partial nail avulsion with phenolisation, and hypergranulation tissue resection.

Understanding the Ingrown Toenail Procedure: What to expect

The experience can vary based on the specific procedure, but here's an overview of the typical process and important information to keep in mind when considering an ingrown toenail treatment.

Assessment for Suitability: We begin by assessing your suitability for the procedure. During this consultation, we discuss the procedure in detail, including post-operative care, and reach an agreement tailored to your needs.
Toe Preparation: Your toe is meticulously cleaned, and we administer local anesthesia to both sides, ensuring complete numbness for your comfort.
Swift Procedure: Once your toe is fully numb, the procedure is performed, typically taking no more than 10 minutes.
Dressing Application: Following the procedure, your toe is dressed with a suitable dressing that is accommodated with running shoes or sandals.
Dressing Care: The dressing should be kept on for 24-48 hours, as discussed during the procedure. After this period, remove the dressing, soak your toe in warm, salty water for 5 minutes, and then reapply a simple dressing. This daily routine should be continued for one week, but up to around three weeks in the case of a partial nail avulsion with phenolisation.
Post-Procedure Monitoring: We'll schedule a follow-up appointment one week after the procedure to assess the healing process and check for any signs of infection. Additional reviews are typically conducted at three weeks and then at the two-month mark to ensure your recovery is progressing and settles perfectly.

Preparation Tips for Ingrown toenail treatment

1. Choose roomy sandals or shoes like running shoes for the procedure day to accommodate the dressing comfortably.
2. Plan transportation in advance; arrange for a taxi or a designated driver. Driving with a numb toe is not safe, and extended walks can promote bleeding on the procedure day.
3. Remove any nail polish from the affected nail before the treatment.
4. Keep pain relievers on hand. Many patients find that taking Paracetamol before the local anesthesia wears off helps manage pain effectively.

Frequently Asked Questions:

1. Do local anaesthetic injections hurt? The needle usually isn't so bad, similar to the feeling of a blood test. However, local anaesthetic is a different pH (acidity) to our tissues so this stings a little as it is being injected. People can experience pain differently so it is hard to predict how much pain you will experience but, most people tolerate it well.

2. How long does ingrown toenail surgery take to heal? A conservative nail cut back removing a spike of nail, or a partial nail avulsion procedure without phenol will normally take around 7 days. A partial nail avulsion with phenol will normally take around 3 weeks. Your podiatrist can give you a more accurate estimated timeframe at your consultation based on your individual case.

3. How do I care for my ingrown toenail after surgery? After nail surgery you are normally advised to bathe the toe in warm salty water for 5 minutes and change the dressing daily. This would be until it appears dry and healed. Wearing wide fitting shoes is also advised to reduce pressure on the healing wound.