Ingrown Toenail - Surgical Correction

An ingrowing toenail is when part of the nail plate pierces the flesh of the toe. It can be extremely painful and can become inflamed or infected. In more severe cases, it can cause pus and bleeding. Ingrowing toenails most commonly affect the big toenail, but can affect any of the lesser toes as well.

Treatments will depend on the severity of the condition and expected outcomes. Non-surgical (conservative) management is an option and involves reshaping the part of the nail that is ingrowing. If the toe is infected antibiotics will usually be prescribed as part of the treatment. Conservative treatment is very effective but not permanent, and will generally require ongoing maintenance.

For those with recalcitrant ingrowing nails or who a seeking a more permanent solution nail surgery is a very effective option. Nail surgery involves removing the side of the nail that in-grows all the way back to the matrix, where the nail is formed and either chemically burning or sharply excising the matrix to ensure this part of the nail doesn't regrow. The remainder of the nail continues to grow as normal.

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What causes ingrown nails?‍

There are many causes of ingrowing toenail, and genetics (as with most medical conditions) have a big part to play here. So, a number of people may inherit an ingrowing toenail. Structural and functional deformities may also contribute. Posture, gait and any foot deformity including a flat foot, bunion or hammertoe are often contributing factors. Some nails are naturally curved or involuted, and naturally grow deep into the sulcus (fleshy part) of the toe.

Tight shoes, socks or stockings may push the toe flesh into the nail where it pierces the skin. Excessive sweating can make the skin susceptible to breakdown, or brittle nails can make the nail susceptible to splintering leaving a spike to grow into the toe. Also worth noting is some medications such as isotretinoin (roaccutane) can increase the risk of ingrowing toenails, as can some presentations of fungal infections.

‍What would happen if left untreated?

‍An ingrowing toenail generally does not resolve without intervention. They continue to be painful and they can become infected. Any infection if left untreated can become serious and life-threatening, resulting in septicaemia.