My toe nail is ingrown... or is it???
What is an Ingrown Toenail?
An ingrown toenail is a common problem where the nail grows into the toe (NHS, 2022). It can feel as if you have a splinter, and be extremely painful and inflamed or infected. Toenails most commonly affected are the big toenail, but it can affect the other toes too. (RCPOD, 2022).
What should I do, whilst I wait for an appointment?
DO- soak affected foot in warm, salty water to help soften the skin and nail and to reduce the chances of infection.
DO- try to keep the foot dry and clean for the rest of the day.
DO- wear wide and comfortable footwear.
DO- take painkillers such as Paracetamol to help reduce pain and discomfort.
DON’T- try to cut or pick the toenail to fix the issue yourself, this often makes the pain worse and harder to resolve the issue.
DON’T- wear tight, pointy footwear. (NHS, 2022).
What happens at the Podiatry Appointment? Is it always Nail Surgery?
Firstly, not all painful toenails are Ingrown. Sometimes Podiatrist’s would call the nail Involuted or Convoluted, which means the nail can curl into the skin but isn’t actually piercing the skin, whereas an Ingrown nail would pierce the skin.
If the toenail is in fact involuted or convoluted, usually the Podiatrist would try firstly to treat conservatively, meaning that usually an Injection of Local Anaesthetic is not required but can be given if the patient is finding treatment painful. The offending area of nail is trimmed away and the area filed to ensure a nice rounded, smooth finish is left to the nail. Sometimes bleeding can occur and a sterile dressing will need to be applied, this usually provides instant relief but is something that needs regularly repeated to ensure the issue does not cause further issues, so sometimes patients may choose to in the future have nail surgery to prevent repeated visits.
When a patient presents with a chronic Ingrown toenail, it will be recommended that nail surgery is carried out. This involves an injection of Local Anaesthetic to the affected toe and the part of the nail that is causing the issue is removed either in part or full, in most cases a chemical called phenol is then used to cauterise and prevent regrowth of the area removed, then a sterile dressing is applied which can be bulky at the first appointment as bleeding does occur. This is a permanent solution in most cases, it is usually over 98% successful and the patient will be required to return for a re-dressing appointment and do re-dressings at home, it can take a number of weeks to fully heal. We recommend no swimming or exercise for ideally a couple of weeks until fully healed. Antibiotics may be required also but this is not always the case. (RCPOD, 2022).
Examples of Conservative Treatment and Surgical Treatment
(Birmingham Podiatry Clinic, 2022. Conservative Treatment Example)
(Cleveland Clinic, 2019) - Typical case that we would carry out nail surgery on this case.
NHS, 2022. Ingrown Toenail [Online]. [Accessed 25 August 2022]. Available from: https://www.nhs.uk/conditions/ingrown-toenail/
RCPOD, 2022. Common Foot Problems: Ingrowing Toenail [Online]. [Accessed 25 August 2022]. Available from: https://rcpod.org.uk/common-foot-problems/ingrowing-toenail).
Birmingham Podiatry Clinic, 2022. Example of Conservative Nail Treatment [Online image]. [Accessed 01 September 2022]. Available from: https://www.birminghampodiatryclinic.co.uk/services-treatments/ingrown-toenail-surgery/
Clevelandclinic, 2019. Example of Toenail that needs Nail Surgery [Online]. [Accessed 01 September 2022]. Available from: https://health.clevelandclinic.org/how-you-can-prevent-and-treat-painful-ingrown-toenails/