How to treat ingrowing toenail (Onychocryptosis)
This Clinical Practice Guideline (CPG) is based on the review of clinical literature and consensus of current clinical practice.
Nails grow from a root beneath the skin called the matrix. This growth centre can vary in size and shape. It may produce a nail which is flat or curved, wide or narrow.
How does ingrowing toenails develop?
Those people with curved or wide toenails are more prone to develop an ingrown nail and occurs when the nail grows into the skin edges that surround it. Improper trimming, injury, shoe pressure, excess skin on the sides of the nail, fungal infections, or even bone spurs under the nail may be a cause of ingrown nails.
What are the symptoms?
Ingrown nails may cause pain at the end of the toe or all along the edge. Pain is often worse in shoes. The edge that is in the skin may cause infection or inflammation. The toe may be red, swollen, or have pus or drainage.
How can it be prevented?
Because of nail shape and other factors, not all ingrown nails can be prevented. However, cutting nails too short may leave a rough edge or a corner that can pierce the skin as the nail grows outward. Cutting the toenails straight across allowing the sides of the nail to be smooth and just over the skin on the end of the toe can help prevent ingrowing toenails.
How is it treated?
At Pioneer Podiatry, our initial treatment goal is relieving pain and clearing infection or inflammation. If the toe is not infected, your podiatrist may be able to carefully trim the ingrown nail edge, without any discomfort. An infected toe usually requires removing the edge (a portion of the ingrown toenail) or, in some cases, the entire nail.
If your ingrown nail is reoccurring, we can perform a procedure called a partial nail avulsion with matrix phenolisation, which involves removing the whole edge of the offending nail and sterilising the nail bed for a permanent solution to your chronic ingrown nail. This procedure is painless as it is performed under local anaesthetic, and the recovery time is very fast. Most people can return to work the next day, as long as they are able to wear an open-toed shoe (eg sandals/ thongs) for a few days.
Details of the procedure
- We will give you a quick local anaesthetic injection so the procedure is pain free.
- We then use special tools to remove the offending edge of the nail (nothing hurts! your toe is numb).
- The next step is to use a chemical called phenol to chemically cauterise the nail bed. This is the most important step, and will ensure the painful edge of nail never grows back.
- We then apply a small post-operative dressing. Most patients can wear their footwear immediately. You cannot drive home, as your toe will still be numb!
- No stitches are required, and the post-operative pain is usually minimal.
- We book in a check-up within the week to make sure it is healing well and no complications have developed.
- In very severe cases, where the nail is severely deformed and causing pain on both edges of the toe, we may recommend a total nail avulsion – re moving the entire toenail to achieve the best result. We will however fully discuss your case and options before proceeding with any procedure. Your private health fund will generally pay a rebate for this procedure.
Healing time is rapid, with full recovery usually within two to four weeks. Most people can go back to work the following day.
Once the procedure has healed, the nail will be a little bit narrower. It is difficult to tell that there has even been a procedure in most cases.