An ingrown toenail is a painful and frustrating condition that is regularly seen and treated by our podiatrists. Ingrown toenails can be deceptive: on the outside, they appear like a ‘minor’ problem due to the small size of the nail and the correspondingly small area of redness and inflammation.
The reality is quite different - ingrown toenails are among the most painful conditions experienced by our podiatry patients, most often producing moderate to severe levels of pain every time you take a step. For some, the pain continues even when they’re resting their feet. This leaves many people unable to tolerate the weight of a simple bed sheet covering their feet at night, let alone the pressure from wearing enclosed footwear for work during the day.
While trimming the problematic toenail back at home seems like a sensible approach, the relief tends to only be temporary and short-lived, with the pain restarting in the days or weeks thereafter. Many then go on to experience recurrent ingrown toenails on the same toe over the following year or several years, leaving them wondering: what can I do to fix my ingrown nail and keep it gone for good?
The good news is that ingrown nails can be fixed permanently, and in just one appointment. Here’s what you should know about ingrown toenails, ingrown nail surgery, and whether it could be the right option for you.
What Are Ingrown Toenails?
To help decide what the best treatment option will be for you, it’s important to understand what an ingrown toenail is. Having an ingrown nail means that part of your toenail, typically down one side of the nail, has pierced and grown into the surrounding skin. Even a small splinter or spicule of nail has the potential to cause significant pain, discomfort or swelling.
Think of the ingrown nail spicule like a small, sharp knife or screw that is stuck in your toe. As it remains pierced in there, the skin cannot close and heal, so the symptoms continue (and even worsen over time). Every time you walk, you feel that stabbing pain, which is why ingrown toenails can continually cause pain throughout the day and night. It's also why ingrown toenails need prompt and effective treatment - and why 99% of ingrown nails don’t get better on their own if you just leave them.
What Do Ingrown Nails Look Like?
Depending on whether your ingrown toenail is mild or severe, it can look anywhere from notably red and swollen at the side of the toenail, to only mildly irritated. One or both toes can be affected, and one or both sides of the toenail may become ingrown. Ingrown nails can also affect the smaller toes, although 95% of the cases of ingrown toenails we see are at the big toe. Another telltale sign of an ingrown nail is pain when touching the side of the toe, or when you press down on the nail itself.
Something to be aware of is that because ingrown nails are technically open wounds, they are vulnerable to becoming infected, which can worsen your pain and symptoms as well as put you at risk of complications. Signs that your ingrown toenail is infected include having yellow, white or clear discharge, having bleeding at the nail, or experiencing severe pain.
What Causes An Ingrown Toenail?
Ingrown toenails can affect anyone at any age - even toddlers and babies. Common causes include:
- Having a poor nail cutting technique. Specifically, cutting deep down the sides of the nails, instead of more straight across, following the natural slight curvature of your toenail
- Purposefully cutting down the sides of toenails - especially if you can’t visualise where your nail clippers are going. This makes you particularly vulnerable to leaving sharp nail edges and spicules behind, which can then grow into the surrounding skin and cause an ingrown nail
- ‘Pulling’ off the nails instead of cutting them properly
- Having existing toe deformities, such as bunions or claw toes, that push toes against one another
- Being born with abnormally shaped toenails (such as involuted or ‘pincer’ nails), or experiencing nail trauma, such as from when something heavy is dropped onto the toes which changes their appearance and the way they grow
- Other repetitive nail trauma, such as from sports involving kicking like soccer
- Poorly fitting footwear - especially tight footwear that has a narrow toe box that presses against the toes
- Sweaty feet that lead to fragile and soft skin that is vulnerable to breaking down
Ingrown Toenail Treatment
So how are ingrown toenails treated? We have several approaches to managing ingrown nails depending on your circumstances, and by far the most popular one is permanent correction using a small, in-chair procedure called a partial nail avulsion.
Partial Nail Avulsion (PNA)
A PNA removes the small section of your nail at the side of the toenail where it has ingrown. A chemical is applied to the nail base that stops that small portion of nail from re-growing in approximately 9 out of 10 people. This is a safe and effective procedure that is completed in under one hour, under local anaesthetic, so you don’t feel any pain. Once the area heals, your skin closes the small gap when the nail section was removed, and you end up with a relatively normal looking nail that you don’t have to worry about becoming ingrown. During the procedure:
- We clean and disinfect the treatment site – your toe and forefoot – to minimise the risk of infection (standard practice with any minor surgical procedure)
- We inject the toe with local anaesthetic using a thin needle. We can apply a topical numbing cream to the injection site prior if needed
- Once we confirm that your toe is numb, we carry out the procedure where we remove the small portion of the nail that is growing into the skin and causing you pain. By removing the nail splinter from the skin, your toe can begin its journey to healing, repair and becoming pain-free again.
- If you’d like to permanently stop the side of the toenail from regrowing, we’ll apply a chemical to destroy the nail growing cells in that specific area, so your nail will not grow back in that area. This is called a ‘chemical matrixectomy’. Some people choose to have the procedure without the matrixectomy, and take their luck as to whether or not the nail will become ingrown again.
- We dress the toe to promote optimal healing.
- We book you in for a dressing change and teach you everything you need to know about how to best care for your toe in the meantime.
Partial nail avulsions hold great benefits to our patients:
- The procedure is done simply in-clinic, in your regular chair - so there’s no need to go to a specialist clinic or doctors office
- The total appointment time typically doesn’t exceed 60 minutes with all of the prep work and after care, with the actual ‘procedure’ time typically around 20 minutes
- The procedure is performed under local anaesthetic so is pain-free
- You do not need to take any additional time off work or school following the procedure and can go home immediately. We do recommend you have someone to drive you home, however, given that it’s best to have full use of both feet for driving and your toe will be numb and you’ll need to avoid pressure from it
- You do not need any special boots or braces while the toe heals
- The procedure causes little post-procedure discomfort, and over-the-counter painkillers can be taken should discomfort arise
- We dress your toe, provide you with a take-home dressing pack and re-dressing instructions
- We monitor your progress to ensure it is healing well, and there are no signs of infection
Other Ingrown Nail Treatment Options
Alongside a partial nail avulsion, there are two other treatment options for ingrown toenails that we offer:
Conservative nail care
Conservative nail care simply means that we’ll trim the offending nail edge back properly and effectively, removing the offending nail spicule without removing a portion of the nail. This may be recommended if it is your first time having an ingrown toenail, or your circumstances mean that it’s unlikely that your ingrown will recur.
Total nail avulsion
A total nail avulsion (TNA) is similar to a PNA, except that the entire toenail is removed instead of just a small side of the nail. This may be recommended if you have extensive nail damage that is leading to your ingrown nail (particularly if your nail has ingrown on both sides) and there’s a good chance that your nail will regrow in a better state. That, or we can still complete a chemical matrixectomy, so that you do not have to worry about toenail pain again.
Frequently Asked Questions
How do you know which ingrown nail treatment is right for you?
At your appointment with us, your podiatrist will examine your toe, get to know your medical history and ingrown nail history, and discuss with you your suitable treatment options, including any benefits, risks and considerations. From there, you’ll have all of the information you need to make the best decision for your circumstances
Is there anyone that ingrown nail surgery isn’t suitable for?
Partial and total nail avulsions may not be recommended for those with a poor blood supply to their feet that impairs their ability to heal, and therefore safely recover from surgery. Those with a history of non-healing wounds or foot and leg ulcers will be examined thoroughly by our podiatrists to determine their eligibility for ingrown nail surgery. Your podiatrist will check your suitability and whether the benefits of having the procedure outweigh any potential risks, so that you’re fully informed.
Will I need time off work or school after my ingrown toenail surgery?
Most people do not need to take any additional time off work or school, given that you are able to take it easy on your feet. This is why we recommend having your procedure at the end of the day, so you can rest in the evening. Having the procedure on a Friday also helps, so you have the weekend to rest. Some jobs are better suited to allow you to take it easy on your feet, so please use your discretion to allow the healing and repair to begin and achieve healing in the fastest time possible. You’ll want to avoid any shoes or activities that place pressure on your toe. This means that in the days following your procedure, shoed sports are not advised, though you can still do workouts like Pilates and yoga. You also want to avoid getting the toe wet, so you will not be able to swim until your podiatrist gives you the all-clear.
Is ingrown nail surgery safe?
Ingrown toenail surgeries are very common worldwide, and we take high precautions to optimise your safety. All of our procedures here at PhysioCentral are grounded in clinical evidence, with a long history of successful outcome. Your surgery is performed only by registered podiatrists. As a regulated profession, we comply with extensive safety and hygiene protocols and requirements, document everything, and are regularly audited, with no issues. As with any surgical procedure, there are always risks, such as the risk of infection. And like with any procedure, we take extensive precautions to minimise the risk of adverse events occurring. If they do, we will support you in managing these circumstances.