Treatment of ingrowing toenails is dependent upon the presenting condition. Often the patient has consulted his GP and may have been prescribed antibiotics if there is an infection present.
A mild ingrowing toenail can often be treated routinely in the surgery, often without local anaesthetic and with little discomfort to the patient.
A moderately ingrowing toenail with symptoms of pain will often require a local analgaesia before the offending nail section can be removed. Severe or chronic ingrowing toenails often require a minor surgical procedure called a partial nail wedge resection (PNA) or less commonly a total nail wedge resection (TNA).
Prior to any decision to surgically treat an ingrowing toenail, the patient has a full half-hour consultation covering their past history which includes the length of time they have had the problem and the number of times it has recurred. The podiatrist will also cover in detail the patient's medical history. These will include any past illnesses, any allergies, any medication being taken and any previous adverse reactions to dental analgaesia.
Once the podiatrist has obtained a satisfactory medical history, the procedure will be explained in detail to the patient and they will be given literature explaining both the surgery and pre- and post-op requirements.
The toe is fully anaesthetised, well away from the site of the ingrowing toenail. This procedure is called a digital block and it is carefully administered after the use of a cold spray to minimise 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 nailplate is then narrower and also 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, thus preventing regrowth. The tourniquet is then removed, bleeding controlled and an antiseptic applied. The patient is then given post-operative instructions and rebooked in four days for a redressing. This is the most common surgical procedure for an ingrowing toenail. There are minimum post-operative complications and usually dependent upon occupation, a quick return to work is possible.
There are other surgical procedures, which are considered in cases of poor circulation and diabetes for patients with recurring nail problems.