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Ingrown Toenails

Ingrown toenails fundamentals

Ingrown toenails most commonly involve the big toe, but can involve any of the toenails. The nail becomes ingrown when one or both sides grow into the skin of the toe. The skin then becomes red, swollen and painful. Sometimes the nail actually breaks the skin and causes a localized infection which may become more acutely painful and cause drainage from the side of the toe. If ignored, an ingrown toenail can cause inflammation of the bone (osteomyelitis), resulting in systemic infection.

Ingrown toenails can be prevented by cutting the toenails after bathing, when they are soft and making sure to cut the nails straight across, only slightly rounding the edges of the nails. You should not cut down into the borders of the nails. After properly trimming the nails, the edge of the nails should be lightly smoothed with a file or emery board. Additionally, you should wear well fitted shoes that are not restrictive in the toe area.

What causes Ingrown Toenails?

Ingrown toenails may be caused by the following factors:

  • The nail grows into the skin rather than gliding above the skin
  • Shoes that compress the nail against the toe skin
  • Thickened nail
  • Toe injury or repeated toe trauma
  • Fungal infections

Ingrown toenails are most commonly caused by shoe pressure, although some people may be born with a tendency to develop ingrown toenails. Thee individuals inherit this directly from one or both parents who may suffer from the same problem. Proper footwear and nail care are the best defenses against ingrown nails.

How is this treated?

Treatment options include:

  • Soaking the foot in a solution of lukewarm water and mild soap (Dreft, Ivory), then applying an antiseptic or topical antibiotic and covering with a bandage when wearing shoes.
  • Allowing it to "air out" in bed at night.
  • Reducing pressure on the toe by wearing open-toed shoes.
  • Taking oral antibiotics to treat infection.
  • Surgery.

What are the risks of treatment?

Typically, surgery is performed to get rid of infection and alleviate pain. Occasionally, the border of the nail may not grow back.

How do I prepare for surgery?

Always ask your surgeon for complete pre-operative preparation instructions. Typically, these may include:

  • Complete any pre-operative tests or lab work prescribed by your doctor.
  • Arrange to have someone drive you home from the hospital.
  • Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
  • Call the appropriate surgery center to verify your appointment time.
  • Refrain from eating or drinking anything after midnight the night before surgery.

What do I need to do the day of surgery?

  • If you currently take any medications, take them the day of your surgery with just a sip of water.
  • Refrain from taking diabetic pills or insulin.
  • Do not wear any jewelry, body piercings, makeup, nail polish, hairpins or contacts.
  • Leave valuables and money at home.
  • Wear loose-fitting, comfortable clothing.

What happens during surgery?

A surgeon may remove a portion of the tissue at the side of the nail groove along with a spike of nail, allowing the groove to reform itself. This results in reduced pressure and irritation. Patients with chronic ingrown toenails may require the use of a special medication – liquid phenol – to permanently remove portions of the nail root or a portion of the nail root can be removed surgically. Here, that portion of the nail plate will not regrow. In severe cases, the surgeon removes the entire nail and root, resulting in no toenail at all.

Surgery is minimally painful and performed on an outpatient basis.

What happens after surgery?

You should be able to put weight on both feet immediately after surgery, but walking will be uncomfortable. Some mild bruising and bleeding is normal after foot surgery. Keep your foot and leg elevated while sitting or lying down and make sure your bandages are clean, dry and intact at all times. If the toenail was infected, you may be placed on oral antibiotics or asked to apply an antibiotic ointment to the area.

Ask your surgeon for complete post-operative instructions.

How long is the recovery period after surgery?

If the nail matrix is not disturbed, then pain relief from an ingrown toenail is almost immediate. If the nail matrix is removed, then full recovery can take up to 3 weeks.

Rehab after surgery

A post-operation shoe is required from 1 day to 3 weeks, depending upon the procedure performed. After that, properly fitted shoes are of utmost importance to avoid future problems.

How can I manage at home during recovery from the procedure?

Typically, normal activities can be resumed in a day or so. The surgical dressing is usually removed by the patient, and a small bandage is applied.

How frequently should I schedule follow up appointments with my doctor following surgery?

Follow-up visits are scheduled by your surgeon.

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