Wednesday, November 30, 2022
Common Foot Problems FOOT HEALTH

Signs You May Need Ingrown Toenail Surgery

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What exactly is an ingrown toenail?

close up hand clipping toenail

An ingrown toenail can occur when a nail edge impinges on the adjacent skin. This can cause you to experience pain, swelling, and even redness. The constant irritation of the skin next to the nail can cause further discomfort when walking. This can later result in an infection that can progress quickly. If this occurs, ingrown toenail surgery may be required. 

Ingrown toenails are most often seen in the great toes, but they can occur in any toe. Chronic ingrown toenails can become a problematic issue and should be taken care of quickly. 

What causes ingrown toenails?

  • Cutting your nails too short
  • Digging into the corners of your nails when trimming
  • Cutting your nail edges in a round manner
  • A family history of ingrown toenails
  • Tight-fitting shoes and socks that impinge on the nail borders
  • Trauma to the nail (such as having your nail stepped on and impacted into the skin)
  • Prior nail removal, as this can cause regrowth of a deformed nail and thus cause impingement
  • Repetitive pressure on the nail from certain sports/dance
  • Fungal nail conditions that cause the nail to become thick and ingrown 
  • Thickness and curvature of the nail that can occur with age

Home remedies and management for ingrown toenails

cutting nails straight
  • Make sure you cut your nails straight across. Do not cut them in a rounded shape, as this places you at a higher risk for nail impingement. 
  • Avoid cutting nails too short. Let your nail grow out past the edge of the toe before trimming the nail straight across
  • Soak your toe in Epsom salts daily to keep the area clean and help with achiness in the toe
  • Use adhesive tape to tape your swollen skin away from the nail daily until your nail edge grows out
  • You can also try stuffing a small amount of cotton between the edge of your nail and nail border to prevent impingement until the nail grows out
  • Wear comfortable shoes that do not put direct pressure on the toes. Avoid high-heels.

When is it time for ingrown toenail surgery?

When traditional home remedies have failed and you notice persistent pain in your toenail, it’s time to visit your doctor for ingrown toenail surgery. 

If you notice a bacterial infection in the nail such as redness, pain, and swelling, contact your doctor immediately. It is extremely important to clear the infection at all costs to prevent a bone infection. 

Untreated chronic infected ingrown toenails can go on to bone infection and can lead to needing prolonged antibiotics and even toe amputation. Your doctor will likely put you on an oral antibiotic immediately. 

Types of ingrown toenail surgeries that can be performed in the office setting

ingrown toenail removal

Slant back partial nail avulsion

This procedure can be done when there is a small piece of nail at the edge of the toe that is impinging against your skin. This procedure rarely requires an anesthetic and is usually performed for a painful ingrown toenail that is not infected. 

A small vertical piece of nail is cut from the affected ingrown nail allowing relief of impingement. This usually requires no significant aftercare and can provide patients with immediate relief. 

Matrixectomy

If the ingrown toenail becomes infected, or a prior slant back procedure has failed, a matrixectomy can be performed. This is a very common procedure that can be done in the office setting. It requires an injection of a local anesthetic to numb the toe. There are 4 nerves in each toe, so all 4 nerves must be numbed up with an injection. Usually, an anesthetic called Lidocaine is used. This will keep the toe numb for up to 2-3 hours.

So does the numbing injection hurt? Yes, the numbing injection may be slightly uncomfortable, but your doctor can apply an anesthetic cream onto your skin prior to injecting the anesthetic to keep you more comfortable.

Then when the toe is numb, the corner of the ingrown toenail is removed from the tip of the nail to the base. 

Check out my video below where I am removing an ingrown toenail.

To ensure that the nail border won’t grow back, a chemical acid called Phenol is used to burn the nail matrix (the area beneath the cuticle which produces nail-creating cells). Antibiotic ointment is applied to the toe as well as a thick bandage. 

Ingrown toenail surgery aftercare

You will need to change your bandage daily. First apply antibiotic cream onto the procedure site, along with non-adherent gauze. Then you can wrap the toe using rolled gauze. You will need to do this the first few days until the drainage reduces.

You can buy a kit with all dressing materials included here.

Most people will need to limit their activities for a day or two, and take over-the-counter anti-inflammatories such as Motrin if they experience pain. It is okay to shower the same day of your ingrown toenail surgery. Avoid high-impact activities like running for about two weeks. 

Eventually, the surgery site will become dry, and the scab will fall off, revealing a natural-looking thinner toenail. 

Other options for ingrown toenail surgeries

Winograd procedure

If you have already undergone repeat matrixectomy procedures and the ingrown toenails keep growing back, your doctor may want to perform a Winograd procedure

This procedure is a bit more aggressive. The doctor will numb up your toe, and perform an excisional wedge resection of the ingrown toenail, adjacent skin tissue, and nail matrix. Once removed, the remaining area would then be repaired using non-absorbable sutures. 

You may notice more scarring with this procedure, but it is very effective because the nail root is excised causing no opportunity for the ingrown toenail to grow back. Sutures would be removed 2 weeks after the surgery. 

Permanent nail removal 

Permanent nail removal stages

If you experience chronic ingrown toenails with chronic infection, you may want to consider permanent nail removal. This would also be a good procedure to do if you have one or two toenails that are very thickened, heavy, and painful. 

Your doctor will numb up your toe with an anesthetic and then remove your whole nail. Then, he or she will use phenol to cauterize your nail matrix to prevent a new nail from growing back. 

Your toe may drain for several weeks, as this procedure is very aggressive, and you will need to be closely monitored. Eventually, the nail bed will heal up revealing an absent nail.

Complications from ingrown toenail surgeries

  • Infection
  • Continued pain associated with the procedure
  • Numbness in the toe/tingling pain
  • Deformed toenail
  • Recurrence of ingrown toenail and need for more aggressive surgery
  • Gangrene if the patient has a poor blood supply and cannot heal the surgical site

What if you bump your nail and your toenail is already somewhat loose?

In this case, your doctor may perform what is called a “Temporary” nail avulsion. Anesthetic would be injected into the toe to numb it, and then the toenail would simply be removed. This would allow for a brand new nail to grow back.

Keep in mind though, that if you have your toenail removed, it will take up to 12 months for a new nail to grow back. Also, the new nail will be slightly thicker.

It may feel odd to not have a toenail. You can keep your toe protected in shoes that have a stiff toe box to prevent injury to your toe.

You can read more about toenail injuries and black toenails in my supplemental article.

Another post you’ll want to check out is what to do if your toenail is falling off.

big toenail

Conclusion

Our toenails are there for a reason, to protect our toes! If you can avoid ingrown toenail surgery, it would be the best option. However, thousands of these procedures are done yearly to alleviate pain and infection. If you think you may need ingrown toenail surgery, make sure to contact your doctor right away. 

healthy toenails

Have you suffered from an ingrown toenail before? I’d love to hear your story. 

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Photo Credits:

Pedicure photo created by freepik – www.freepik.com

Manicure and pedicure photo created by valuavitaly – www.freepik.com

Disclaimer: The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition or treatment before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Vaishnavi Bawa
Dr. Vaishnavi Bawa is a Podiatrist who specializes in treating foot and ankle pathology. LifesLittleSteps mission is to educate the public about foot health in an easy-to-understand manner using evidence-based medicine.
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