A solution to Ingrown Toenails: Nail Surgery

They are without a doubt one of the most uncomfortable foot problems we see on a daily basis.

An ingrown toenail is something I’ve experienced personally and I wouldn’t wish it on anyone. However, it is one of the most common presentations in our clinic. It usually affects the big toe but can be seen on the lesser toes too. If left untreated and uncared for it can cause infection at the site of the ingrowing nail. We often hear ‘ I didn’t like to bother you as I felt it would settle itself over a few days’ – this is something I stress to my clients regularly – when it comes to nails, always get it checked as soon as possible as it increases the chance of a successful conservative treatment.

An ingrown toenail can be caused by
-          poor nail cutting technique.
-          peeling the nail off instead of taking the time to tidy the nails properly.
-          poor footwear choices.
-          sudden trauma.
-          Certain nail shapes can be predisposed to it 

A lot of the time we can use conservative treatments and avoid the need for nail surgery. However, sometimes a more permanent solution is required when the issue repetitively presents itself. It is also needed when best efforts using conservative treatment are unsuccessful.

In my practice I don’t actually like to use the term ‘surgery’ as I feel our clients can get the wrong idea and think it is a major, drastic and invasive procedure. It is in fact a very successful solution for an ingrown toenail and provided the correct aftercare is carried out, healing can be very quick. The actual procedure takes less than 30 minutes and with pre and post op checks the entire appointment should last about an hour. There is no major downtime following the procedure however, we would recommend taking it easy for a minimum of 24 hours following the appointment. After that, it is a straightforward road to recovery in most cases and you can return to wearing normal footwear as soon as the initial dressing has been removed and a new smaller dressing applied(usually 24-48 hours after).

What happens in a nail surgery?
Your toe will be numbed with local anaesthetic and a segment of the nail that is causing the issue is removed. To prevent that segment of nail growing back and causing a recurrence of the ingrown toenail, a substance called phenol is applied to the nail bed. Phenol stops the nail from regrowing. The area then has to be kept clean and given time to heal. Some discomfort is expected for the administration of the LA but the good news is that there is no discomfort throughout the procedure due to the LA. In my experience post-operatively patients report a quick and marked improvement in discomfort caused by the ingrown toenail. Personally speaking – having nail surgery on my own toe was one of the best decisions I have made.

Podiatrists are fully trained in University in the procedure of Nail surgery and administration of Local Anaesthetic. However, until recently, podiatrists in Ireland were unable to obtain the local anaesthetic due to some conflicting laws. Thankfully, after a very long battle to get there, our society ‘Podiatry Ireland’ has secured a pathway for Podiatrists to be able to carry out Nail surgery using LA. From the 2nd March we at Podi Footcare will be able to provide Nail surgery to our patients.

Written by Megan Staunton – Podiatrist at Podi Footcare