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What to know about Ingrown Toenail Surgery

An ingrown toenail, otherwise known as onychocryptosis, is a common complaint. About 20% of people who see their doctor f need further help with ingrowing toenails.

Ingrown toenails are common and usually treatable without surgery. However, in severe cases, people may need a small medical procedure to treat an ingrown toenail. This can be done in our clinic  under a local aneasthetic as a day case procedure

If they notice them at an early stage, people can treat ingrown nails without. In severe cases — especially when the nail has become infected — people may need to see a doctor for advice, antibiotics, or a surgical procedure.

This painful condition happens when the toenail grows down into the skin. It most commonly affects the big toe, with the corner of the nail growing into the nail bed. In most cases, it occurs due to tight fitting footwear or improper trimming of the nails. This can also occur due to the change in shape of the nail which may become thickened.

People can treat ingrown toenails with simple non operative measures including salt water soaks and avoid wearing tight shoes that may put pressure on the toe and keeping the area clean to help it heal on its own.

However, recurrent infection can damage the nail and the toe further. People should seek medical care for an ingrown nail if they have the following health conditions — such as diabetes, nerve damage, or poor circulation — this makes treatment  more risky as poor circulation may impair antibiotic delivery and wound healing. Patients may need further medical work up.

Ingrown toenails irritate the skin. This allows bacteria and other microbes to enter, which increases infection risk. Prompt treatment reduces this risk. Signs of infection include:

  • swelling
  • pus
  • redness
  • extreme pain
  • a fever if the infection has become more severe

Black Line: Area of Nail plate removed to the left

If the toenail is swollen or inflamed, and does not get better after a few days, a doctor may diagnose an infection and prescribe antibiotics. They might also prescribe a special splint to prevent the toenail from growing deeper into the skin. If the toe still does not heal, a doctor may recommend surgery.

Some cases may need radiographic imaging/X-rays prior to surgery to rule out underlying bony issues with the hallux that may result in the change in shape of the nail plate. These can be organised prior to your surgery and reviewed as necessary.
You will be assessed for other medical conditions that may affect the nail plate.

Toenail Surgery is an outpatient procedure.

Ingrown toenail surgery  involves the use of local anaesthesia which means you remain awake, but the area is numb so you cannot feel the toe.

Common surgeries for ingrown toenails include:

Wedge resection : a portion of the toenail is removed to prevent it digging into the skin. This procedure is also called a partial nail plate ablation. The germinal matrix (the area where is the nail grows from is then burnt with phenol)

Surgery on the tip of the toe : If other surgeries are unsuitable for a person, or previous procedures have failed, one may remove and reshape the soft tissue at the tip of the toe.

Surgical Matrixectomy : This procedure may be necessary if nail removal or wedge resection fails. 

The nail bed  may need to be cut is there is pus to relieve swelling or drain infected tissue.

Before and After Surgery

If the nail bed is infected then you may need antibiotics during the postoperative period.

A person can help speed their recovery after ingrown toenail surgery by

Keeping the foot elevated

soaking the foot in warm water or salts daily

taking a nonsteroidal anti-inflammatory drug (NSAIDS) to help with pain and swelling

Take antibiotics as recommended

keeping the wound bandaged as instructed

keeping the wound clean and dry, except when showering or cleaning the area

avoiding strenuous activity that puts pressure on the nail 

wearing proper shoes that are not tight

avoiding touching  the wound

For most people, the wound heals within weeks. The pain will steadily lessen in days and has gone when the wound heals. 

You will be given a flat shoe after the surgery to walk on.