Ingrown toenails develop when the sides of the nail cut and pierce into the surrounding skin. This can cause pain, redness, swelling and possibly an infection.

Common causes of an ingrown can include damage to the nail following a sports injury, an object dropping on the nail or alternatively inappropriate cutting of the nail.

Signs of an infection may include:

Swelling

Redness

Pain

A hot sensation in the area

Pus

Bad odour

If you do suspect an infection, or pain does not settle after a few days, then arrange an appointment with your specialist as soon as possible.

Treatments may include:

Conservative Cut Back

If the issue is not too severe or infected, then your specialist may just need to cut or trim the nail. This can stop the nail from pushing into your skin and subsequently reduce pain, swelling and reduce the risk of an infection. A procedure may be advised at a later stage, especially if the ingrown nail is a recurrent problem.

Antibiotics

If the area is infected then your specialist may provide you with antibiotics, typically this is taken for one week. If symptoms persist following, then a procedure may be suggested.

Surgical Options

If you have a persistent, infected or recurrent ingrown toenail, or a fungal nail, then Mr Hester may suggest having the nail partially or fully removed. The procedure can also be carried out with the use of a chemical called phenol, this is applied to the nail bed to stop the nail from growing back, this is typically applied when you have a recurrent issue. This procedure is usually carried out as a minor outpatient procedure under local anaesthesia, you can leave directly following rather than being admitted into a hospital. Mr Hester will start by cleaning the toe and injecting local anaesthesia to either side of the base of the toe. Once numb, the section of the nail or whole nail will be cut down to the base of the nail. The nail will be removed and hypergranulation tissue (scab under the nail) will be removed. It’s suggested that you take a cab home and rest for the remainder of the day, you can return to non manual work the following day. For the first 3 weeks you will need to re-dress and salt water bathe the toe daily. The salt bath is typically 500ml of warm water with 3 heaped tablespoons of salt dissolved soaking the foot twice a day for 10 mins per time. At two weeks postoperative you can continue with high impact activities.

Excision of the Nail Bed

If you have had a recurrent ingrown toenail, which has previously been partially or fully moved, then your specialist may advise on excision of the nail bed. This will remove the root that contains the cells where the nail grows, this will stop the nail from growing back. The procedure may be carried out under local anaesthesia or sedation, you will typically be admitted into hospital for half a day. Mr Hester will excise the corner of the base of the nail and remove the root, alongside the affected section of the nail that is causing you pain. This is then closed with stitches. Following the procedure you should rest at home for 3 – 5 days. You should avoid high impact activities for the first 3 – 4 weeks.

Subungual Exostectomy Procedure

Ingrown toenails can also be caused by a subungual exostosis, this is where a small bone spur on top of the bone underneath your nail. This can cause the nail to lift and push into the sides of the toes. Prior to surgery X-rays are carried out to confirm the presence of the bone spur. The procedure can be carried out under local anaesthesia or sedation as a day case, you will typically be admitted into hospital for half a day. Mr Hester will start by making an incision at the top or the end of the toe. The nail may need to be partially or fully removed so that they can access the bone spur, the bone spur is removed by specialised instruments and the wound is then stitched. You should rest at home for five days following the procedure. Stitches are removed 10-14 days following the surgery. The wound should be soaked in salt water and re-dressed daily until the wound has healed. You will need to avoid high impact activities for three-four weeks.