Onychocryptosis (ingrown toenails) is a very painful condition, in which a spike or sharp edge of a nail has pierced and penetrated the skin surrounding the nail. It occurs most frequently in the big toe and can affect people of all age groups. The pain is a result of the nail spike penetrating the deeper layers of the skin, and causing an acute inflammatory response. If not treated, an infection can develop which will cause pain, and swelling within the toe, and problems with fitting shoes.
There are a number of factors that may cause ingrown toenails; with faulty nail cutting and pressure from ill-fitting footwear the primary causes. Conditions that alter the appearance and shape of toenails such as thickened (Onychauxis) and fungal nail infections may also predispose to the possibility of sharp edges.
If you suspect you have an ingrown toenail or your nail is sore, it is important to have it assessed and checked by a Podiatrist. The toenail infection and swelling will not resolve spontaneously, and for this reason it must be appropriately treated. A number of different treatment options are used dependent on the stage of the ingrown toenail and the possible infection.
Treatment can range from simply removing the offending nail spike, antibiotic therapy and in some cases, a minor surgical procedure (done in the chair) to remove the nail portion permanently.
What is ingrown toenail surgery and how is it done?
There are many procedures that have been developed over the years to address chronic or recurrent ingrown toenails. These range from quite invasive procedures requiring stitches and considerable change to the visual appearance of the toe and nail, to less invasive procedures with minimal post operative pain and less cosmetic effects.
At Heal & Soul Podiatry our preferred procedure for ingrown toenails is, a partial nail avulsion and matrix sterilisation (nail bed removal) done under local anaesthetic. This has been shown through research to be the most reliable form of procedure, to reduce the risk of recurrence caused by a regrowth of the nail. Nail surgery is generally very safe, with very minimal pain afterwards, and can be safely performed within our clinic.
This procedure involves removal of the outside edge of the nail, and the nail root (matrix), the cells which are responsible for nail growth, are destroyed by a chemical (phenol). It is done under a local anaesthetic toe block, which means there is no discomfort during or immediately after the procedure, and you can return home directly afterwards. Cosmetically, the nail plate will look slightly narrower once fully healed, and this is usually barely noticeable.
After the procedure, you will be sent home with the toe bandaged and instructions on what to do (pain medications, elevation, rest, keep dry, etc). Typically, your podiatrist will review you within a couple of days and change the dressing, and then given you instructions on self management of the toe (ie changing dressings yourself) over the coming 1-2 weeks. Your podiatrist will then normally review the toe as needed to make sure it is healing properly, and then follow up with you as necessary afterward.
Most people are able to return to work the day after surgery however we recommend wearing roomy shoes to prevent unecessary pressure on the toe.
Who is suited to having ingrown toenail surgery?
Most sufferers of chronic ingrown toenails will be suitable for the procedure, however there are some situations where this may not be appropriate. This includes patients with medical conditions where there is poor circulation in the foot, certain medication treatments, or if there are other health problems your podiatrist feels may affect your ability to recover suitably from the procedure.
What if I am ‘needle-phobic’ or anxious about medical procedures?
We understand that some people can be very worried and anxious about having minor surgery under local anaesthetic. If you are ‘needle-phobic’ or suffer from anxiety about the procedure, we are able to provide you with some options for sedation to reduce your stress and concerns. You should discuss this with your GP who may prescribe something suitable for your surgery.
Please contact us if you are worried or concerned about having injections, or the procedure in general, and talk to one of our friendly podiatrists about your options.
What are the Benefit and risks?
The principle benefit of ingrown toenail surgery is to provide a permanent solution to chronic pain, discomfort or infected toes. Left untreated, chronic ingrown toenails can in some circumstances lead to severe infections, affecting the toe bones and causing a deep infection known as osteomyelitis, which can be very difficult to treat.
There is a high success rate of 95% that the nail will not regrow.
No surgical procedure, no matter how large or small, is without risk.
The most common issues that may occur following ingrown toenail surgery are infection, recurrence or delayed healing. Typically, the chance of developing any of these problems with ingrown toenail surgery is very small, and measured at only a few percent of all surgical cases in healthy individuals.
Because of these potential risks, our podiatrists will discuss these issues with you, and ask that you complete a consent form to indicate you are aware of these risks before we undertake toe nail removal.