Ingrown Toenail

 Nail Troubles

 An ingrown toenail results in pain along the margins of the toenail.  They are often aggravated by wearing shoes, particularly those with narrow toes.  

The toe may be sensitive to any pressure, even the weight of bed clothes.  There may be signs of infection and drainage of pus, or a watery discharge tinged with blood.

Ingrown toenails may be caused by:

• Improper trimming of the nail.
• Tight fitting shoes which compress the toes together.
• Hose or socks which are too tight.
• Abnormally shaped nail plate.
• Other toenail deformities
  (i.e. excessively thick nail plate).
• Trauma to the nail plate or toe. 

Complications may include:

• Infection, if present, may spread to the foot and leg or into the blood stream.
• Loss of nail plate from infection or inflammation of the nail bed.
• Chronic ingrown nails can cause deformity of the nail plate and/or surrounding soft tissues.
• A small benign tumour called a granuloma can form along the nail margin. 
• On rare occasions the nail may re-grow.     

What you can do:

• Cut toenail straight across and leave it slightly longer than the end of the toe.
• Avoid tight fitting foot wear.
• If discomfort develops, try soaking the foot in a basin of warm salt water two to three times a day.
• If you are diabetic or have poor circulation the water should never exceed 95° Fahrenheit or 35° Celsius.
• An infected ingrown toenail requires prompt professional attention.  Contact your Chiropodist or physician immediately. 
• If an ingrown toenail cannot be resolved conservatively, removal of the offending nail may be required

** Diabetics and those with poor circulation to the feet must never attempt to treat an ingrown toenail at home.  Consult with you Chiropodist or physician immediately.  **

Nail Surgery

 This patient suffered from a chronic ingrown toenail on the outside (lateral) border of her large toe (hallux).  The location is marked with an arrow.

1. The toe is anesthetized, prepped with antiseptic and a tourniquet.
    
2. The lateral border of the nail has been removed. 
    
3. Liquefied phenol is applied to cauterize the nail matrix (growth area) and nail bed.
    
4. The chemical cautery is complete.
    
5. All wrapped up and ready to go home. 

The procedure is painless as the toe is “put to sleep” with a local anaesthetic agent.  There is minimal post-operative discomfort. 

The wound heals in about four to six weeks. During this period it is simply dressed with topical antibiotic and band aids. 

After healing, the nail is normal in appearance, somewhat more narrow than before.  The incurvated nail border is gone, leaving the toenail unlikely to be ingrown again.