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Ingrown Toenails

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

One of the main complaints seen by podiatrists are ingrown toenails. Some people may suffer from them only once, whilst others may have continually recurring problems.nail surgery Stafford

An ingrown toenail occurs when a piece of the toenail becomes embedded into the surrounding skin. Organisms 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 seriousness of an ingrown toenail depends on the level of infection and your personal health. A healthy person may find that the discomfort is mild and the infection only 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 person with poorly controlled diabetes) the condition can become quite serious as the infection can begin to spread into the rest of the body.

Causes of ingrown toenails

Footwear is a big contributor to ingrown toenails. Footwear that is tight at the front can squeeze the toes together and encourage the nail to pierce the skin. Steel capped boots and high heeled shoes are some of the usual culprits 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. Athletes involved in sports with a lot of side-to-side movement and a lot of uphill and downhill activity are more prone to ingrown toenails.

The shape of your feet, toes and toenails can make you more susceptible to ingrown toenails. 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.

 

Prevention of ingrown toenails

The best way to prevent ingrown toenails is to address the particular cause. First look at your footwear. Tight fitting shoes can squeeze the toes and loose fitting shoes cause too much movement. Check out our Perfect Shoe page for details. Well ventilated shoes allow your feet some time to breathe. Trim your  toenails in a straight line or along the shape of the nail and gently file sharp corners away. Leave any deep cutting or digging into the sides of the nail to a podiatrist as you may run the risk of creating a bigger, deeper problem.

Treatment for ingrown toenails

There are a few options for treatment of ingrown toenails.

  1. A short 5 minute soak in warm salted tap water can aid in cleaning the area.
  2. Dressing the toe with an antiseptic like betadine, and keeping it clean and dry can also help.
  3. Infection will require a course of antibiotics.
  4. Your podiatrist can help by removing the offending piece of nail, either temporarily or permanently.

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

 

Surgery for ingrown toenails

What is toenail surgery?

Ingrown toenail surgery involves the removal of part or all of the toenail under local anaesthetic. A chemical can be applied to the nail bed and nail matrix to prevent regrowth. There is a small possibility that the toenail may regrow. Infection from poor care after the surgery is the main cause of regrowth. Healing after the procedure usually takes between four to eight weeks.

A full health assessment must be completed before any toenail surgery can be booked. This assessment involves looking at your current medications, medical history and current health status. Bring along a list when you first see the podiatrist. If you are suitable for the procedure 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. Open toe shoes are best.
  • 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

  • Local anaesthetic is injected into both sides of the toe which may cause some discomfort.
  • Once the toe has been fully anaesthetised the podiatrist will remove part or all of the nail.
  • Toenail re-growth is prevented by applying a chemical to the nail matrix.
  • A sterile dressing is applied to the toe.
  • 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 or anaphylaxis.  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.

Reapplying the dressing

  • The first redress of the toenail is within three days of the procedure. The bulky dressing should be replaced with a small sterile dressing. You will be shown how to re-dress the affected toe and can continue to change your dressing every 2-3 days at home if you are able. We can arrange for your dressings to be changed if you are unable.
  • Following toenail surgery the toe will weep and stay moist at first. Small amounts of blood or clear/straw coloured discharge are normal and are an essential part of the healing process. This discharge does not mean that the wound has become infected.
  • Do not use antiseptic creams, solutions or dressings other than what has been supplied/recommended to you as these can affect the healing process.
  • If you experience a sudden increase in temperature, pain or excessive inflammation/swelling around the toe this may indicate that the toe has become infected. Contact your Podiatrist or GP for further medical advice.