NY Podiatrist - Ingrown toenail

Ingrown toenails occur when the nail penetrates the skin at the side of the nail plate. This causes a wound (or foreign body reaction) that can become infected. In some instances this results in extra tissue forming that can bleed easily.

What causes ingrown toenails?

Often, they are due to the shape of the nail plate. Some people have wide nail plates, others curved nail plates which means the nail cannot easily grow free at the sides. This makes cutting the sides of the nail very difficult and often results in the nail being pulled at this point. If a spike of nail is left or causes a small tear in the skin, a wound is formed and infection can follow. Trauma to the nail plate or swelling of the surrounding skin can also cause an infection and therefore IGTN.

What are the symptoms?

• Pain
• Swelling
• Bleeding / weeping
• Foul odor
• Difficulty in shoes
• Difficulty walking

The infection and swelling generally gets worse if untreated.

How is it treated?

This is easily diagnosed on clinical examination.

Simple measures / palliative treatment may be all that is required.

For more severe or recurrent cases, surgery is required.

There are two types of operation:

• Partial nail removal (avulsion) with destruction of the nail bed / root
• Surgical excision (Winograd)

The most common procedure is removal of the side of the nail. Whilst this alone will resolve the infection, the nail will regrow and possibly cause the same problem. Destruction of the nail bed and root (matrix) prevents re-growth. This is usually achieved by using a chemical (phenol) although this can be achieved via an electric current. In some instances, surgical excision of the side of the nail plate, bed and root are necessary. These procedures have high success rates.

The partial nail avulsion using chemical ablation (destruction) rarely causes any significant discomfort. There is slightly more discomfort with surgical excision, although this is generally only mild to moderate.

When will I be able to walk again and wear shoes?

For the partial nail avulsion using chemical ablation, you can walk immediately after the operation, although it is generally best to rest that night. You will need to bathe the foot in warm salt water for 15 minutes, twice daily and redress the toe until it has healed. This is generally between 2-4 weeks due to the chemical burn but it is not usually painful during this period.

For the surgical excision procedure you will need to rest your foot for 2-3 days and sutures (stitches) are removed at two weeks.