Ingrowing Toenails

Definition

This is a condition in which the nail plate penetrates the skin, usually at one of the corners. However, it may be both corners or the centre of the nail plate growing down into the toe. An ingrowing toenail is often accompanied by inflammation (redness) or sepsis (infection). Pain and swelling is often present. Ingrowing Toenails

Causes

  1. Occasionally babies are born with or develop ingrowing toenails very early on. Antibiotics are usually prescribed in these cases.
  2. In-growing toenails are common in teenagers due to a combination of thin nail plate and moist skin.
  3. Trauma/injury to the nail can often result in an ingrowing toenail.
  4. Poor nail cutting often leaving a nail spike.
  5. Difficult shaped nails, for example, involuted nails: these are curved when viewed from the front.
  6. Sport, for example, skiing or football.
  7. Poorly fitting shoes causing compression.
  8. Certain foot mechanics, for example, feet that tend to roll-in.
  9. Onychotilamania: this is the habitual biting of toenails by children.
  10. A combination of two or more of the above causes.

Treatment

This is dependent upon the presenting condition.

  1. If infection is present your GP may prescribe antibiotics. These often reduce the pain and swelling due to infection, but will not deal with the ingrowing toenail itself. If this is not treated the symptoms of pain and swelling will recur once the course of antibiotics is completed.
  2. A mild ingrowing toenail can be treated routinely in the surgery, often without a local anaesthetic and with little discomfort to the patient.
  3. A moderately ingrowing toenail with symptoms of pain will often require a local anaesthetic before the offending nail section can be removed. Dependent upon the cause of the ingrowing toenail, this often resolves the condition.
  4. Severe or chronic ingrowing toenails (long-standing or recurring) often require a minor surgical procedure called a "partial nail wedge resection" or less commonly a "total nail wedge resection". The toe is fully anaesthetised, well away from the site of the ingrowing toenail, near the webbing. This procedure is called a "digital block", and carefully administered causes only minor discomfort. This block numbs the whole toe and no pain is felt during the procedure. A tourniquet is placed around the toe to prevent bleeding during surgery and a line is marked on the nail prior to the offending section being removed. The ingrowing section is then separated and removed. The nail plate is then narrower and gives a good cosmetic result. A chemical called Phenol is then applied for three minutes to destroy the nail bed of the area of nail removed and this prevents the nail growing back again. The tourniquet is then removed and an antiseptic dressing applied. The patient is then re-booked for redressing. This is now the most common surgical procedure for an ingrowing toenail. There are minimum possible post-operative complications and usually dependant on occupation, an immediate return to work is possible.

**There are other surgical procedures which are considered in cases of poor circulation and diabetes**

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