Ingrown toenails are one of the most common foot problems seen in podiatry practice. It most commonly presents as a painful inflammation of the big toenail sulci.

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There are three stages of ingrown toenails:

1. Where there is no obvious clinical lesion.

2. Inflammation of skin with associated fluid and pus.

3. Hypertrophy where there is overgrowth of skin in the sulci.

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Common causes include:

• Poor fitting or tight shoes.

• Hyperhidrosis of the skin.

• Pincer or involuted shaped nails.

• Trauma.

• Cutting nails too short.

• Not cutting nails straight.

• Use of acne medication isotretinoin.

• Juvenile diabetes.

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Early ingrown toenails can often be treated by podiatry management involving clearance of the nail edge to stop the nail cutting into the skin. We also recommend the use of betadine solution and dressings the wound to protect the area from infection.

 

​We don't recommend self-clearance as the chance of not clearing the nail properly or causing more severe infection is high.

Ingrown toenails that involve severe pain, pus, swelling and redness of skin around the nail especially down to the proximal nail bed are signs of severe infection and recommend urgent oral antibiotics you should see you GP urgently.

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With more severe ingrown toenails, they need to be cleared also down to the nail bed and this done under local anaesthetic. The use of local anaesthetic can be painful and may not be suitable for children. In this case,nail procedures can be performed under general anaesthetic by general surgeons.

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​For ingrown toenails that will not resolve, we can perform nail surgery to permanently remove or resect it and apply acid to the nail bed to stop it re-growing.  This is performed under local anaesthetic.

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The benefit of this treatment includes little post operative pain and reduced infection due to the analgesic and antibacterial effect of the phenol, fast recovery time and low chance of regrowth - 4.3%.

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Complications of this procedure include narrow nail, nail spike regrowth, separation of nail on regrowth, burns to surrounding skin and bone infection.

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People over the age of 60 are at increased risk of infection associated with this procedure done in a clinical setting and hospital surgery might be appropriate for at risk patients.​

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