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Ingrown Toenails

They are a common and painful condition in which the side or the corner of a toenail grows into the soft flesh of the toe, usually the big toe.

Ingrowing toenails happen when a sharp nail, often the big toe nail, grows incorrectly and cuts into the skin. As the nail grows and penetrates deeper into the flesh, an inflammation often occurs, and eventually becomes infected. The skin then appears very red, swollen and tender to the slightest pressure.

Causes of Ingrown Toenails

Ingrown toenails are often caused by ill-fitting footwear, a poor nail-cutting technique, and keeping the feet in wet conditions for too long.

Shoes that are too narrow (or too shallow) force the sides of the nail to fold and grow into the toe. Flat-feet (rolling in of the foot) increases the pressure on the toe when walking, so that the nail pushes into the flesh of the toe.

Incorrect nail cutting techniques such as nails cut too short allow the nail to embed itself into the protruding soft tissues. Nails cut obliquely around the corners of the nail encourage the nail to embed itself into the grooves on the sides of the nail.

Treatment of Ingrown Toenails

In most cases, a conservative treatment will be sufficient, i.e. remove the part of the nail that is ingrowing with fine nippers. The edge of the nail will then be carefully smoothed with a special file, and the cut flesh will be disinfected and thoroughly dried.

From then on, your podiatrist will demonstrate a proper nail cutting technique, and suggest the use of orthotics for a well-positioned foot, as well as properly fitting footwear.

In some cases a minor surgical correction will be necessary. In that case, the podiatrist will, under local anaesthetic, remove the edge of the offending nail and destroy the growing cells of the nail at its base, usually with phenol, sometimes with acid, to prevent regrowth. This is only a minor intervention and normal activity can be resumed within the next couple of days. (See below.)

Ingrown Toenail Surgery

Nail surgery may be necessary if in the long term the nail keeps ingrowing, despite conservative treatment. Surgery will consist of painlessly cutting the nail away partially or completely. This is done under local anaesthetic. The offending part of the nail will be carefully cut off, so that the rest of the nail's surface is flat.

The podiatrist will then use a chemical solution to kill the part of the nail bed where the ingrowing edge was growing from, so that the nail will not re-grow from there again. The cavity will then be packed and covered with an antiseptic dressing. The patient will now be free to walk out pain-free, relieved, and with a new-found comfort in their feet!

Three to four days after the surgery the podiatrist will need to see the patient again to renew the dressing and check the healing progress. Although it will probably be much more comfortable to walk soon after the surgery compared to before, it is necessary to rest the foot as much as possible.

For any questions about ingrown toenails, nail cutting, or our treatment procedures, give us a call.