INGROWING TOE NAILS

WHAT IS AN INGROWING TOE NAIL?

Ingrowing toenails are one of the most common and most painful conditions to affect our feet. They occur when a spicule of the toenail pierces the skin on the nail fold.  This leads to pain and secondary infection.  You need to get these treated properly to avoid the infection spreading into the bone.

 

WILL ANTIBIOTICS CURE MY INGROWING NAIL PROBLEM?

Whilst a course of antibiotics may be helpful to dampen the infection, in the end patients require proper treatment.

 

WHAT TREATMENT WILL I NEED TO CURE THE INGROWING TOENAIL?

The long-term solution to cure an ingrowing toenail is to have the offending section of nail removed.  This can be done under local or general anaesthetic (patient preference).  Mr Metcalfe has performed  thousands of these operations and the procedure is very straight-forward, safe and effective.  There are two main types of procedure and the choice is important if you are to get the best result.  Click on one of the links below to discover more.

WHEN SHOULD A PHENOL PROCEDURE NOT BE DONE?I

It is certainly the case that treating ingrown nails with a "phenolisation procedure" is technically easy to do and provide reliable results, there are situations in which they must be avoided.  Phenol causes a chemical burn and thus the wound heals by secondary intention over a number of weeks.  In any patient with poor healing capacity there is a real risk of delayed healing, secondary infection.  This can in some cases result in loss of limb!    Conditions which must be carefully considered carefully include:

  • Vascular insufficiency (to the toes)

  • Metabolic e.g. Diabetes mellitus

  • Immuno-suppression e.g. steroids, biologics

  • Connective tissues disorders e.g. scleroderma

Any Podiatrist undertaking nail surgery must ensure that there is sufficient healing capacity to proceed with the proposed procedure.  

WHAT WILL HAPPEN IF I DON'T GET TREATMENT?

As the nail which is "digging-in" acts as a foreign body it causes an inflammatory response and attempts to heal over the offending nail section.  Two things can happen.  Firstly you can develop a secondary infection which if left untreated can spread.  Secondly the body makes something called "granulation tissue".  This is very vascular "cherry red" tissue which bleeds easily when knocked.  

CASE EXAMPLE

This man had spent a long time suffering with an ingrowing nail. Repeated attempts as cutting down the side of the nail resulted in a very infected and seriously risky problem.

WHAT SHOULD I EXPECT BEFORE THE PROCEDURE?

Before anything is planned you will receive a detailed medical assessment.  Normally this will include:

  • Review of your medical history

  • Medication review

  • Check of any allergies

  • Examination of the toe(s) to ensure the diagnosis is correct

  • Detailed check of your circulation which may include Doppler assessment / Toe pressure 

WHAT OTHER CONDITIONS CAN CAUSE SIMILAR PROBLEMS?

There are quite a few other conditions that can cause symptoms similar to an ingrowing toe-nail. These include:

  • Adenosarcoma

  • Melanoma

  • Sub-ungual exostosis