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Ingrown Toenails


“I can’t even stand the weight of the bedsheets on my toe!”

If you have ever suffered an ingrown nail, you will appreciate just how excruciatingly painful they can be.

Ingrown nails are a major complaint seen by all podiatrists. Some patients may suffer from them only once, whilst others may have continually recurring problems.

An ingrown nail (or onychocryptosis) occurs when a piece of the toenail becomes embedded into the surrounding skin. Your feet are usually your contact with the ground, and as such are exposed to all sorts of organisms that can take advantage of this broken skin and quickly create an infection to the local area. Next, your body will recognise the invading nail as a foreign body and begin to fight it from the inside – causing inflammation. The area can become red, swollen, painful, and sometimes there may even be the presence of pus. The site becomes a horrific battleground leaving you to contend with the negative effects of the carnage.

The seriousness of an ingrown nail depends on the level of infection and your personal health. A young healthy person may find that the discomfort is mild, or temporary, and the infection may be localised only to the tip of the toe. If it is a longstanding infection, or if it occurs in someone who has a reduced immunity (such as a poorly controlled diabetic patient) the condition can become quite serious as the infection can begin to spread into the rest of the body.

Ingrown nails can be caused by a huge variety of factors.

Footwear is a big contributor. Footwear that is tight at the front can squeeze the toes together and encourage the nail to pierce the skin. Steel capped boots and heeled ladies dress shoes are some of the usual suspects in this case. Conversely, shoes that are too loose can cause the foot to slide around in the shoe, literally causing the toes to bash against the sides. This is particularly relevant in athletic shoes where lots of emphasis is placed on running, side-to-side movement, or endurance activities like hiking.

Some causes aren’t as easy to control, and can be put down to the makeup of the foot. Soft, sweaty feet can cause the skin to be broken easily. Your foot posture may also lend itself to pressing the toes together closely, particularly in the case of the big toe and the second toe. The nail shape can have a tendency to curl deeply into the sides (the sulcus). Damaged nails from injury, or a fungal infection can cause the nail to have an irregular shape which may have more likelihood of having sharp edges. Finally, poor nail cutting technique can leave small jagged edges on the nail which can easily pierce the skin.

The best way to prevent an ingrown nail is to address the particular cause. Ensure your footwear is a proper fit, and neither too loose or too tight around the toes. Allowing your feet some time to breathe, and wearing shoes that are well ventilated are important if you have feet that tend to be soft and sweaty. Ensure nails are trimmed either in a straight line or along the shape of the toe, with sharp corners gently filed away. It is recommended that you leave any deep cutting into the sides of the nail to a podiatrist as you may run the risk of creating a bigger, deeper problem.

There are a few options for treatment of your ingrown nail, however it is important to note that until the cause of the ingrown nail is identified and resolved the problem is likely to recur again.

A short 5 minute soak in warm salty water can aid in cleaning the area. Dressing the toe with an antiseptic like betadine, and keeping it clean and dry can also help. In cases of infection, your GP can prescribe antibiotics. Or your podiatrist can help by removing the offending piece of nail, and retrain the nail to grow in a more orderly shape.

Sometimes the ingrown nail is persistent, and recurs repeatedly. In these cases, a nail wedge procedure may be an option. This is a minor procedure that your podiatrist can perform that involves removing a small side of the nail and destroying the cells responsible for creating that part of the nail (germinal calls). This procedure is performed under local anaesthetic, and so is relatively painless. For most healthy people the toe heals very quickly, and it is quite rare that the problem will recur.

Your Brisbane podiatrist is always happy to discuss any concerns you may have regarding any toe or nail problems.


Preparing for Nail Surgery and Your Aftercare

What is nail surgery?

Nail surgery is the removal of all of the toenail (total nail evulsion or TNA) or part of the nail (partial nail evulsion or PNA). A local anaesthetic (LA) is used so that you will feel no pain during the procedure. After the removal of the nail, a chemical may be applied dependant on the requirements called phenol to the exposed nail bed and nail matrix to prevent regrowth (However, there is a small possibility that some nail regrowth may occur). Healing usually takes between four to eight weeks.

Prior to surgery a pre-op assessment/consultation will be performed to assess your suitability for surgery. During this assessment a thorough check/run through of your current medication, medical history and current health status will be reviewed and assessed. If you are suitable and you wish to proceed, written consent is required. If you are planning a holiday up to 10 weeks post surgery you should inform the podiatrist at this point.

On the day of the surgery

  • Please remove all traces of nail varnish.
  • Do not drink any alcohol.
  • Eat a normal light meal before the surgery.
  • Take any medication as normal unless advised otherwise.
  • Bring suitable footwear that will fit over a bulky dressing.
  • Bring a list of any current medications you are on including any inhalers or angina sprays.
  • We advise you not to drive for 4 hours after the surgery, and therefore suggest that you arrange transport home prior to the nail surgery appointment.

The procedure

  • There are three stages to the procedure – A local anaesthetic will be injected into both sides of the toe. The local anaesthetic may cause some discomfort when being injected into the toe.
  • Once the toe has been fully anaesthetised, the podiatrist will then either remove part of or the entire nail and may use a chemical (Phenol) to destroy the nail bed.
  • A dressing will then be applied.
  • The full procedure will last around 45 – 60 minutes.

Possible side effects of local anaesthetic

In extremely rare cases, local anaesthetics can cause an allergic reaction/toxic reaction.  All precautions are taken within the clinic to deal with this should this clinical emergency arise.

You must inform the podiatrist of any previous reactions or complications that may have happened if you have had a local anaesthetic in the past.

After surgery

  • The toe may remain numb for up to 4 or more hours. You should rest the affected foot as much as possible, especially in the first 24 – 48 hours by raising it on a pillow or cushion
  • Take your normal everyday painkillers to reduce any discomfort (if needed) and follow the instructions on the patient information leaflet. If you have been prescribed aspirin by your GP or consultant you should continue to take this.
  • Keep the dressings dry and in place. A small amount of blood/fluid may appear through the dressing. This is normal. However, if you experience a lot of bleeding which cannot be stopped by raising your foot, you should seek medical advice.
  • Avoid drinking alcohol following the surgery.
  • You may need time off from school or work. It is important to avoid any undue pressure or injury in the toe, it maybe advisable to inform your teacher/employer of the procedure that has been carried out.
  • Avoid strenuous exercise or sport until the nail bed has fully healed.


  • The first redressing will be undertaken within three days of the surgery. The bulky dressing will be replaced by a smaller sterile dressing. You will be shown how to re-dress your affected toe/s and can continue to change your dressing every 2-3 days at home if you are able. If not we can arrange for your dressings to be changed.
  • Following nail surgery the toe will weep and stay moist at first. Small amounts of blood or discharge are normal and are an essential part of the healing process. This discharge does not mean that the wound has become infected. Because phenol has been used the toe may become more inflamed with an increase in discharge 2-3 weeks after the surgery. This is a normal chemical reaction and is not usually a cause for concern.
  • Do not use antiseptic creams, solutions or dressings other than what has been. supplied/recommended to you as these may affect the healing process.
  • If you experience a sudden increase in temperature, pain or excessive inflammation/swelling this may indicate that the toe has become infected. Please contact your Podiatrist or GP and seek medical advice. Further treatment may be required.