What is an ingrowing toenail?

An ingrowing toenail is where a piece of nail pierces the flesh of the toe. It can feel as if you have a splinter, and be extremely painful and inflamed or infected. In more severe cases, it can cause pus and bleeding. Ingrowing toenails most commonly affect the big toenail, but can affect the other toes too. A nail that is curling (involuted or convoluted) into the flesh, but isn’t actually piercing the skin, isn’t an ingrowing toenail but can feel very painful and can also appear red and inflamed.

What causes it?

There are many genetic factors that can make you prone to ingrowing toenails, including your posture (the way you stand), your gait (the way you walk) and any foot deformity such as a bunion, hammer toes or excessive pronation of the feet (when your foot rolls inward excessively). Your nails may also have a natural tendency to splay or curl out instead of growing straight, encouraging your nail to grow outwards or inwards into the flesh.

One of the most common causes is not cutting your toenails properly, such as cutting nails too low in order to relieve the pressure and discomfort of an involuted nail.

Tight footwear, hosiery and socks can also push your toe flesh onto the nail so that it pierces the skin. If you sweat excessively or don’t rotate your footwear, the skin becomes moist and weak and is easily penetrated by the nail. If you have brittle nails with sharp edges or are in the habit of breaking off bits of nail that are sticking out, you are also more likely to get an ingrowing toenail.

Less common is a fungal infection or in some cases particular types of medication, for example isotretinoin.

Who gets it?

Active, sporty people are particularly prone, because they sweat more. Younger people are more likely to get it (as they pick their nails more, compared to older people who may not be able to reach their toes!).

How do I know I have it?

The most common symptom is pain followed by inflammation in the surrounding nail area.

However, not everyone identifies an ingrowing toenail correctly. Sometimes, they have a curly nail which has a lot of debris (dirt or fluff) underneath it or a corn or callus down the side of the nail, which can be just as painful. However, if it’s a corn, you tend to experience a throbbing pain as opposed to the sharp pain you get with an ingrowing toenail. If this is the case, your podiatrist will remove the debris, and, if necessary, thin the nail.

Is it serious?

Not usually, unless you have an existing condition such as diabetes, poor circulation or a reduced immune system. However, if left untreated, infection can develop in the rest of the toe and foot, and in very rare cases get into the blood stream. The quicker you deal with it, the less painful the treatment.

What are the treatments?

Before you are seen by a podiatrist, you can relieve the discomfort by bathing your foot in a salty footbath which helps to prevent infection and reduces inflammation. Then apply a clean sterile dressing, especially if you have a discharge, and rest your foot as much as possible.

How a podiatrist will treat you will depend largely on the severity of your condition:

• For the most basic painful and irritable ingrowing toenail, the offending spike of nail will be removed and the toe covered with an antiseptic dressing
• For toes too painful to touch, a local anaesthetic will be injected before removing the offending portion of nail
• For involuted nails, part of the nail that is curling into the flesh is removed and then the edges of the nail are filed to a smooth surface
• For any bleeding or discharge from an infection, or even excessive healing flesh (hypergranulation tissue) around the nail, antibiotics will be prescribed to manage the infection as well as having the offending spike removed
• For those particularly prone to ingrowing toenails from underlying problems such as poor gait, a partial nail avulsion (PNA) may be recommended along with finding a more permanent solution to the underlying condition. This procedure is done under a local anaesthetic where part of the nail is removed (including the root), leaving a permanently narrower nail. In some cases a total nail avulsion (TNA) may be performed, where the entire nail plate and root are removed. In either case, the chemical phenol is used to cauterise the nail and prevent it regrowing. This is over 95% successful. It will require return for 3-4 weeks after surgery for a few re-dressings.

How can I prevent ingrown nails?

Firstly, learn to cut your nails properly! Nail cutters aren’t a good idea because the curved cutting edge can cut the flesh, and nail scissors can slip. It’s best to use nail nippers (available from chemists or our clinic) because they have a smaller cutting blade but a longer handle. Cut your nails straight across mainly but slightly rounded to the shape of the toe and don’t cut too low at the edge or down the side. The corner of the nail should be visible above the skin. Also, cut them after a bath or shower when the nail is much softer.

Good hygiene can go a long way to preventing ingrowing toenails. Avoid moist, soggy feet by rotating your footwear so each pair has a chance to dry out thoroughly. Avoid man-made materials (synthetics) and choose socks and shoes of natural fibre which fit properly. Keep your feet clean and dry and in the summer wear open-toed sandals to let air get to your toes as much as possible.

If you have diabetes, are taking steroids or are on anti-coagulants, don’t attempt to cut your nails or remove an ingrowing spikes of nail yourself.

Surgery for Ingrown Toenails – Partial Nail Ablation (PNA)

Michael Abrahams performs an operation to remove an ingrown toenail for Channel 4’s Embarrassing Bodies program and gives you an idea of what can be done to eradicate these problems permanently. Skip forward a minute if you want to get straight to the procedural information!

If the nails are excessively thickened and damaged the entire nail can be removed to relieve the pressure from shoes.

Our assurance

Our surgery is unrushed, thoughtful and caring. We will take the time to explain fully the treatment options and help you decide the most appropriate course of action.
We have experience with children and nervous patients and have worked with hypnotherapists in the past for needle phobia and anxiousness.
Our surgery fees are inclusive and cover the procedure and follow up appointments.

How will the ingrown toenail be removed?

You will be given an injection of local anaesthetic which will make your toe numb.
Once the toe is numb, the podiatrist will then remove part of the edge of nail – usually a millimetre or two. A chemical will be applied to destroy the exposed nail bed and normally ensures that the nail will not ingrow again.
A dressing will then be applied to the toe and you will be able to walk normally, although you are advised not to drive whilst the toe is numb.
It is advisable to bring loose fitting or open toed footwear with you on the day of the procedure.
Ideally avoid sport and strenuous use of the feet for the following week but time off work/school is seldom required.

Will it be painful afterwards?

Some patients may experience discomfort after the anaesthetic has worn off and we advise a painkiller such as paracetamol to be taken whilst the toe is still numb. Most are pleasantly surprised at how comfortable the toe is now that the excess ingrown toenail is no longer digging in!

Painkillers may be continued for the following couple of days but usually only if required.

Dressings and Follow-Up

You will normally be advised to attend the clinic for a short appointment a few days later then a week after the operation being carried out.

The toe will require dressings on a daily basis at home and your Podiatrist will discuss with you the most suitable arrangements to ensure that your toe receives appropriate care until it is healed. This usually involves soaking in warm salt water for 2-3 minutes and applying a dressing to avoid sock fluff and dirt getting in the toe!

It is normal to experience localised pinkness or redness around the side or base of the toe. A yellow discharge is also expected for 2-4 weeks after the treatment as the toe heals.

Availability

Prior to surgery you would have been seen for a consultation or received prior treatment. You may have a referral letter from your Doctor or Podiatrist.

If you have a referral letter or believe that you require surgery then we are happy to see you for consultation and surgery at the same appointment. We tend to ask you to email us a picture of your toe first and have a telephone or email consultation first to check suitability.

We will ask you general questions about your health.
Specific interest is with patients taking warfarin, aspirin or other blood thinning medicines.
We rarely carry out the treatment during pregnancy except when the toe keeps becoming infected and the toe nasty and inflamed.
We may arrange antibiotics for patients who suffer with immunodeficiency conditions but are not required for those with heart murmurs or implants. In the majority of cases clearing the nail removes any infection and the phenol used to kill the nail bed of that area off is antiseptic.

Should you wish to discuss Nail Surgery further, or should you have any questions about the information provided here, please speak our practice manager or you can email a picture. In any event we usually suggest a consultation first to ensure its a suitable procedure. If its an emergency we will endeavour to be able to fit you in.

Costs

Current costs will be shown on our online booking page. At the time of writing this page – a first appointment and treatment at the clinic is £60 for simple cases. If an anaesthetic is required then there is an additional £70 charge. The cost of surgery (PNA) is as a package costing £330 for one toe and £430 for two toes.

Out of hours or emergency appointments would have a higher initial charge and would be discussed at the time e.g. weekends.

Some information is from the Royal College of Podiatry website

This is an initial appointment to discuss and possibly treat ingrowning toenails. This is not a surgical appointment. If you need to book surgery for your ingrown nails please use one of the links below.