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in-growing toe nail





An in-growing toe nail occurs as a result of the edge of the nail curving inwards. This causes pressure on the adjacent skin, which can become painful and infected. It most commonly affects the big toe, but can affect the other toes on occasions.

What are the symptoms?

The main symptom is pain. If infection of the side of the nail occurs, this can become swollen and red, with a foul discharge. It can be painful if footwear presses on the side of the nail. The toe, when infected, is unsightly and it is painful to walk.

What is the treatment?

  • Non-surgical treatment – this is always attempted in the first instance. A short course of antibiotics may be needed if infection is present. The advice of a Chiropodist or Podiatrist should be sought on the correct technique of cutting toenails. They will also advise on attempting to encourage the nail to grow away from the skin edge. If symptoms are not settled in this way, it may be appropriate to consider surgery.

  • Surgical treatment – there are a number of surgical procedures to treat in-growing toenails. These are detailed below.


Wedge Resection

This involves removing the edge of the nail that is causing the symptoms. The base of the nail bed is destroyed with a combination of surgical removal and the use of a substance called Phenol. It is occasionally necessary to remove both sides of the nail. This will cause the nail to grow in a flatter, narrower shape. Occasionally, despite a wedge resection, the in-growing toenail can recur. If this happens, a nailablation may be necessary.

Nail Ablation

If recurrent in-growing toenails continue to be a problem, particularly if wedge resection has failed to cure the symptoms, then it may be necessary to completely remove the nail and prevent its regrowth. This is known as nail ablation and will usually settle the symptoms. Surgery itself is relatively straight forward and can be carried out as a day case procedure, often under local anaesthetic. Dressings will be changed regularly post-operatively until the wounds have healed. Despite the ablation, there remains a small risk of recurrence of the problem.

What are the complications of in-growing toenail surgery?


As with all surgery, there is a risk of infection. This is increased in this type of surgery, as the surgical site is often infected as a result of the in-growing nail. Dressings will be changed regularly in the post-operative period and it may be necessary to have a short course of antibiotics to settle any infection. It can take a few weeks for the surgery to fully heal.

Specific to in-growing toenail surgery is a risk of recurrence of the problem. Should this occur, it may be necessary to re-operate with a more invasive procedure to settle the symptoms.
 
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