Ingrown Toe Nails

 A true ingrown toenail occurs when the sides of the toe nail begin to pierce or grow deep to the skin along the nail edges. There is likely to be pain and inflammation at the edges and the end of the toe. 

There may be a build up of fluid and swelling in the area surrounding the toe. The skin along the edge of the nail may being to 'hypergranulate' with the appearance of a red, angry cauliflower. There may also be bleeding with white or yellow pus discharging from the affected area.

The big toe is most often affected, either on one or both sides but the lesser toes can also be affected. They tend tend to occur in adolescence but can happen at any age.

Toe nails may become painful for other reasons but not necessarily because the nail is ingrown. Thickened, crumbling nails due to fungal infections, as well as being unsightly, can cause discomfort and pain with inflammation of the surrounding toe.

Involuted nails, where the normally flat nail plate becomes extremely curved, can severely pinch the nail bed and toe, increasing pressure and thereby causing pain and inflammation. While not a true ingrown toe nail, they can be equally painful and affect one or more toes, possibly leading to other problems such as infection.

Trauma to the nail from footwear, corns under or around the nail or poor nail cutting technique can lead to skin abrasions and openings, allowing in infection if not treated appropriately. Bacterial Infection within toes can be lead to pain, discharge and swelling. 

A number of problems can cause an ingrown toenail to develop. These may include:

Badly cut toenails – Poor toe nail cutting technique may encourage the nail to impinge on the skin along the nail edges or 'sulcus'.

Tight-fitting shoes– The skin may be pierced by the nail if the pressure applied to the nail and toe is high for long periods of time.

Damp or sweaty feet – Softened skin around toenails may allow  the toe nail to pierce  and embed itself within the sulcus easier.

Trauma or injury – Stubbing your toe can sometimes cause an ingrown toenail to develop.

Nail shape – The sides of curved or fan-shaped toe nails are more likely to press into the skin surrounding the nail.

Fungal nail infection - As well as being unsightly, this can cause your toe nail to thicken, widen or break leaving rough, sharp edges that may be uncomfortable or painful.

You should see your Podiatrist if your ingrown toenail is badly inflamed, bleeding or is discharging pus as it may be infected, especially if you have diabetes as this condition may affect how your toenail heals.

 Conservative Treatment

Following your assessment, the Podiatrist will gently remove a small portion of the leading and side edge of the problem toe nail where it pinches or presses on the skin causing pain or discomfort. 

This can usually be carried out  quickly and with the minimum of discomfort using a simple procedure. Occasionally the Podiatrist may be able to apply to small amount of anaesthetic cream to help make the procedure more comfortable. A small dressing is applied and left in place for 24 hours. A course of antibiotics may be provided if infection is present.

For most painful, involuted or mild ingrown toe nails, this is the first and best course of action and can resolve the problem in the medium or long term.

Depending on the severity of your symptoms or if your toe nail does not improve following conservative treatment, nail surgery may be recommended.  

Owing to clinical considerations, nail surgery is not a treatment that can be provided in the home. Where surgery is necessary and the distance to our clinic is an issue for you, we will refer you either to a local Podiatrist or your local NHS service. Please speak to your Podiatrist for more information.

Nail Surgery: Partial Nail Avulsion

This involves removes part of the toe nail. It is the most commonly used procedure for treating ingrown toe nails and is 98% effective. 

A local anaesthetic is used to numb the toe. The edges of the toe nail are cut away leaving a slightly narrower, flatter nail. A chemical called phenol is applied to the area where the nail was removed to prevent it growing back and becoming ingrown in the future. A short course of antibiotics may be provided if the toe is infected.

Nail Surgery: Total Nail Avulsion

A total nail avulsion completely removes the toe nail. This may be necessary if the nail is thick and pressing into the skin surrounding the toe, such as with severe fungal infection or deformed nails.

Where the toe nail has been removed, there may have an indentation where the nail used to be. However,  following the removal of a problem fungal nail, you may request that phenol is not used. This would allow the nail to return in time, usually 6 to 12 months. Discuss this with your Podiatrist for more information.

Either procedure is usually carried out in around 45 minutes.  Please refer to our price list for more information.

After Surgery

After toe nail surgery, the toe will be dressed in a sterile bandage. This will help stem any bleeding and prevent infection. Driving is not advised following the procedure. Suitable wide or open toe footwear to accommodate the bandage will be required. To help reduce the pain, painkillers such as paracetamol can be used. Wearing soft or open-toed shoes for the first few days after surgery is recommended.

The foot will need to be rested and kept raised as much as possible for 1 to 2 days after the procedure. A follow up appointment will be arranged to change the dressing and check the toe. Afterwards, the dressing is changed daily at home by the patient until the toe is healed. Depending on the individual, this may take 6-8 weeks. 

Taking care of your feet will help prevent foot problems such as ingrown toenails.  Left untreated, an ingrown toenail can become infected so it is important to:

- Wash your feet every day with soap and water. Dry them thoroughly and use foot moisturiser. 

- Change your socks or tights every day.

- Cut your toe nails straight across the top only, not at an angle or down the edges to prevent impingement of the surrounding skin. 

- Only ever wear comfortable shoes that fit properly with plenty of space for the toes.