As one of the most common problems that we treat, patients will often have had courses of antibiotics from their GP, several sessions of Chiropody and may have had a persistent pain for months or even sometimes intermittent episodes for years. There are several causes of ingrowing toenails, and various levels of severity. The treatment of choice is often a Nail Wedge Resection procedure. This takes around 30-45 minutes and is performed under local anaesthetic. It involves removing a small section of nail and chemically destroying the part of the nail bed where it grows. Click here for preoperative evaluation, procedure details, complications, risks and post operative care. Following are some of the common causes of ingrowing toenails: Inherited: Some people grow very wide and rounded nail plate Poor Nail Care: The way you cut your nails may leave sharp spikes Footwear: Tight shoes may press on the side of the toenail Injury/infection: Changes the growing area of the nail bed. Toenails can take about nine months to grow from the nail base to the top of the toe. Sometimes problems begin when pressure from footwear distorts the growth of the nail, or the nail is trimmed into the curved shape. This allows one of its vertical edges to pierce the groove in which it lies.
Ingrowing toenail stage 1 Mild An ingrowing toenail often looks as though there is nothing wrong with the nail, but it hurts in shoes, to touch and sometimes even bed clothes cause pain. This is often due to a slight curviture of the nail, tight shoes or poor cutting techniques. Simple trimming by a chiropodist or podiatrist will usually help to resolve this problem. If not treated will often progress to a Type 3 Ingrowing toenail.
Involuted toenail ingrowing toenail stage 2 ingrowing toenail non infected ingrowing toenails This problem is often seen in those over 50 when the nail has excessively curved, or sometimes following damage either from some type of trauma or following fungal nail infections. Areas of corns and hard skin build up in the nail borders, causing pain and sometimes becoming infected. If caught early podiatry/chiropody treatment is the management of choice or will often progress to Type 3 Most common is the infected and inflamed ingrowing toenail, sometimes very painful, the skin around the nail appears swollen and red and sometimes pus may be visible under the skin.
Infected mild ingrowing toenail, may not look bad but can produce significant pain This is the classical ingrowing toenail, often found in teenagers or poor management of Type 1 or 2 above. This type of nail problem can also be managed by a podiatrist, sometimes with local anaesthetic if painful.
Infected ingrowing toenail with hypergranulation tissue If the nail has become ingrown several times, or the shape of the nail is so badly deformed that it is likely to re-grow, a decision may be made to remove part of the nail root. The end result will produce a normal looking but slightly narrower nail. If the nail has become very deformed or if removing side sections would achieve an unsatisfactory result then the final option is to remove all the toenail
Treatment is as above, but sometimes the nail plate may be removed initially and then the side sections removed a few months later due to the extensive infection.