Ingrown Toenails and Nail Surgery

Ingrown toenails are very common and extremely painful. For those that have been unfortunate enough to experience them, will know how memorable the pain can be. However, most don’t actually know that treatment is quick and instant relief is provided. Most people struggle with trying to cut it out themselves causing further infection and bleeding. A pedicurist is definitely not the place to get treatment, as one patient told me this morning “I went to a pedicurist because i didnt know about podiatrists “.

An ingrown toenail is simple an inflammation of the skin beside the toenail, and can sometimes also have an infection. Most common causes are nail spurs caused by trauma and incorrect cutting of the nail, or oddly shaped toenails. What i want to focus on today is the oddly shaped toenails that keep causing an ingrown toenail. This nails tend to be either fan-shaped or very curved caused pressure on the sides. The treatment that i often recommend to this presenting problem is to either attend periodically (every 6-8weeks) for regular re-shaping of the nail or have a permanent procedure, called partial nail avulsion (“nail surgery”). The latter option is what i will focus on today, as many do not know what it entails.

Partial Nail Avulsion with Phenolisation

This method involves removing the margin of the nail on the offending side only. The podiatrist may recommend doing the other side if there is high risk of future ingrowns occurring there also. Following injection of a local anaesthetic in the toe and then the application of a tourniquet, the podiatrist will remove the edge of the nail growing into the flesh and destroy the matrix area with phenol to permanently and selectively ablate the matrix that is manufacturing the ingrown portion of the nail (i.e., the nail margin).  Also, any infection is surgically drained. After this date, other suggestions on aftercare will be made, such as salt water bathing of the toe and daily application of an antiseptic. The goal of the procedure is that the nail does not grow back where the matrix has been destroyed and ingrown toenail does not re-occur. The nail is slightly narrower after the procedure but barely noticeable once healing is complete. The surgery is advantageous because it can be performed in the clinic under local anesthesia with minimal pain following the intervention. Also, there is no visible scar on the surgery site and a nominal chance of recurrence.

The most common reasons why patients delay this procedure is :

1. Fear of having needles : I can understand this fear, as no-one likes needle injections and some of us may have had negative experiences. But often, my patients will say “It wasnt that bad”. Their anticipation of the pain is far worse than what it actually is. We carry out the procedure on young children, and i have had my fair share of very anxious children but suprisingly, they sit in the chair calm and collected throughout the injection.

2. Fear of permanent change to the nail shape : This particularly applies to females, as no-one wants to have an ‘ugly’ looking nail. During the pre-operative consultation, I will draw on the nail, the portion to be removed. If this doesn’t suit you, then it can be reduced if it doesnt compromise the results. The podiatrist, especially myself, attempts to keep your nail looking as normal as possible, so only a minimum amount is removed. before any procedure, i spend quality time with my patient to gauge exactly what their concern is and what they are hoping to achieve. No two people are alike, and so no two consultations are ever the same.

3. Unaware that podiatrists treat ingrown toenails: Many people visit the GP when they have an ingrown toenail and then may get referred to see a surgeon. Podiatrists are very experienced, and skilled practitioners that treat ingrown toenails on a regular basis. Treatment options vary and based on the patients history and severity. Take the time to see a podiatrist and receive some quality time to discuss and treat your painful ingrown toenails, with minimal cost and pain.

Dr Vanessa Hadchiti (Podiatrist)