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Ingrown Toenail

Ingrown toenail is a condition in which a spike, shoulder, or a serrated edge of the nail has pierced down the side of the nail fold. When this happens, it can lead to inflammation, swelling or accumulation of pus at the side/s of the nail.  Hypergranulation (excess tissue growth) can also be seen on the nail folds in severe cases. Most common factors that lead to ingrown toenail are: faulty nail cutting, wearing poor fitting footwear, tearing of the toenails and excessive curvature of the toenails.

If the ingrown toenail is not infected, the nail splinter can be gently removed by one of our Podiatrists. Narrow pointed footwear should be avoided to prevent direct excessive pressure. A suitable antiseptic solution such as Betadine can be used to treat and prevent any infection. If this is a recurrent problem, a nail surgery will be necessary to permanently remove a small part of the nail.  Occasionally we may recommend removing the entire toenail to achieve the best result.

What is ingrown toenail surgery?

Ingrown toenail surgery is a partial nail excision and chemical sterilisation of the nail matrix performed under local anaesthetic. It involves the removal of the ingrown portion of the toenail, together with the corresponding portion of the nail root, and the application of phenol to prevent that portion of the toenail from regrowing. This procedure is performed under local anaesthetic and the prognosis is generally very good. We perform ingrown toenail surgery in Peel Podiatry Clinic consultation rooms under sterile conditions. The procedure takes approximately one hour.

If you are taking Aspirin or Warfarin, please check with your Doctor or Pharmacist on whether it’s safe for you to go off them for 1 week before your surgery. This helps to minimise bleeding afterwards.

Is ingrown toenail surgery painful?

Our surgical technique for ingrown toenail is a minimally invasive procedure that requires no cutting of the skin and no stitches. This reduces the time it takes the toe to heal and minimises any postoperative pain.

Prior to surgery, we administer a local anaesthetic that numbs your entire toe for one-two hours, so there is no pain during or immediately after the procedure. If there is any discomfort once the anaesthetic wears off, it is usually well managed with paracetamol, rest and elevation of the foot.

Do you remove the entire toenail?

In most cases, we only need to remove one edge of the nail. Once the toe is healed the toenail simply looks slightly narrower, and it can be difficult to tell that there has been any surgical correction.

In more severe cases, where the nail is severely deformed and causing pain on both edges of the toe, we may recommend removing the entire toenail to achieve the best result.

Can an ingrown toenail grow back after surgery?

Yes, there is a chance an ingrown toenail can grow back after surgical treatment, but this only happens to about 5% of cases. Our Podiatrists are well trained and will take their time to thoroughly cauterise the affected nail to minimise the risk of an ingrown toenail recurring.

Will I need time off work or school?

Immediately after the procedure you should rest and keep your foot elevated for the rest of the day. You will also need to wear an open-toe shoe for one to two weeks, and avoid high heels and tight-fitting footwear.

Most people recover very quickly from ingrown toenail surgery and are able to return to work or school within a day or two. You should not participate in physical education, sport or swimming for two weeks after the procedure.

If your occupation is in a physically demanding or dirty environment, we suggest you arrange your surgery to coincide with some time off work.

Will I need to take antibiotics?

With any surgical procedure there is a risk of developing an infection as the wound heals. It is important that you follow our instructions for cleaning and dressing your toe, and that you keep your toe clean and dry.

We will review your foot regularly after surgery to ensure your toe is healing well. As long as there are no signs of infection (increasing pain, pus, heat, redness or swelling), it is unlikely you will need to take antibiotics.

What do I need to do on the day of my surgery?

  • Bring a slipper or sandal to wear for the return journey home. This will allow room for the toe dressing which may be bulky.
  • Make transport arrangements for your journey home. You will be able to walk after the operation but you should rest the foot as much as possible. You are strongly advised not to drive until the effects of the local anaesthetics have worn off.
  • If you are under 16 years of age you must be accompanied by a responsible adult.

What can I expect after my surgery?

  • Usually there is some postoperative bleeding. This is one of the main reasons we encourage you to rest and keep your foot elevated for the rest of the first day as soon as you get home.
  • Minor pain and discomfort to the operated site/s. This can be controlled by Panadol or your preferred choice of analgesics obtained over the counter in any pharmacy.
  • Some clear discharge and the appearance of granulated tissues from the operated site 2-6 weeks after the surgery, which occurs as a result of the chemical burn effect of the phenol.
  • Your first and second dressing changes will be performed by your Podiatrist.  Appointments will be made accordingly.
  • Keep the surgery site clean and dry for at least one week, but two weeks if possible.

How do I look after my wound after the surgery?

  • It is paramount that you keep the operated toe clean and dry for the first 3-4 days. Your podiatrist will do your first dressing change after this period. We will give you extra Fixomull to hold the dressing down in case the original tape is peeling off.
  • We find a good way to keep your foot dry in the shower is to wear a disposable latex glove onto your foot & seal the cuff with duct tape. Common precautionary approaches must be taken when standing & moving in the shower as it can be quite slippery.
  • We advise you wear socks to bed to avoid the dressing accidentally falling off.
  •  If your dressing gets wet, you must take it off ASAP, flush the wound with sterile saline solution, dry it with sterile gauze and apply the sterile dressing. We have provided these items in your after care pack.
  • Your podiatrist will do a second dressing change 3-4 days after the first.
  • After the second review you can now look after the wound at home. You can apply Betadine solution or an antiseptic solution of your choice to the wound and dress it with a sterile dressing. Please change your dressing daily and please keep it dry if possible for another week.

Want to know more?

9586 3046

For further information on this condition or any other foot problem, please contact our friendly staff of Podiatrists at Peel Podiatry Clinic