Ask the doctor: Is surgery the answer to my ingrown toenails?

By | February 23, 2021

I suffer from ingrown toenails and have done for years. I don’t wear high heels or tight shoes, but no matter what I do I can’t seem to manage it. Is there surgery available that can sort it?

ngrown toenails occur when a spicule of the lateral nail plate pierces the lateral nail fold and penetrates the skin. The resultant ‘foreign body reaction’ causes pain, inflammation and sometimes infection that can be very debilitating.

There are a number of reasons why an ingrown toenail can occur such as poorly fitting shoes/socks/tights, improperly trimmed nails, excessive sweating, soft tissue abnormalities of the toe, and inherent nail deformity. If you have a normal nail shape then it is likely that a nail spike created by improper trimming of the lateral edge may have caused your ingrown toenail.

The first step in management of mild ingrown toenails (pain, redness and swelling) involves warm water soak with tea tree oil or Epsom salts up to four times a day for 10-20 minutes. Also applying a cotton wick in the lateral groove can help gently uplift the corner of the nail that is digging into the skin. A chiropodist can help at this stage with gentle retraction of the nail fold and by trimming the offending nail spike. A cotton nail cast is where a piece of U-shaped cotton is placed between the nail plate and inflamed tissue, and secured with a cyanoacrylate liquid glue that hardens and effectively forms a temporary cast.

Step two is for moderate ingrown toenails that may exhibit the additional signs of infection and sometimes a purulent discharge. A prescription for topical or oral antibiotics such as fuscidic acid or flucloxacillin (provided you are not allergic to penicillin) should do the trick.

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After the infection is treated and the pain and inflammation settles down, an injection with a nerve block to the toe is generally needed in order to apply a curette and/or silver nitrate stick to remove any granulation (abnormal excessive wound healing) tissue.

You must clean the nail with a hydrogen peroxide solution and cotton swabs two or three times per day and apply a topical antibiotic ointment. You will be followed up closely to ensure the lateral nail plate grows beyond the lateral nail fold.

The third option is surgical and is generally considered for patients who suffer recurrent ingrown toenails or for moderate to severe ingrown toenails with signs of chronic inflammatory changes. In the majority of cases, a partial or complete removal of the lateral nail is curative, but in some cases it only serves as a temporary measure.

A procedure called matricectomy (chemical or surgical) can be performed by removing the lateral nail bed matrix, ensuring that the lateral part of the nail will not regrow. This destroys all or part of the nail matrix so that a new nail plate cannot regrow.

Total nail avulsion involves the removal of the entire toenail and may be considered if your nail is thick and pressing into the skin surrounding your toe.

These procedures can take up to one hour and are generally done under local anaesthetic. You do not need to wear any special boot/footwear post procedure. Recovery can take anything from two weeks to two months depending on the procedure.

Dr Jennifer Grant is a GP with Beacon HealthCheck

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