Dorset Foot & Ankle Clinic

Figure 1 –Patient with a nasty infected ingrowing toenail. This nail was simply removed to allow a new nail to grow. If the new nail is also ingrowing then the whole nail will have to be removed and prevented from growing again by the Zadek procedure

Ingrowing Toenails

Ingrowing toe nails most commonly affect the big toe, although can occasionally cause problems in the lesser toes. They occur as a result of the edge of the nail curving over. This causes pressure on the adjacent skin which can often become painful and infected. They can be prevented by avoiding pressure on the nail of the big toe and cutting the toe nail straight across, thereby preventing the corner of the nail from growing into the skin.

Treatment

1. Non surgical treatment.

We would always recommend attempting non surgical treatment in the first instance. If infection is present a short course of antibiotics may be necessary. Treatment by a Chiropodist or Podiatrist with advice on the correct technique in cutting toe nails should be sought as well as attempting to encourage the nail to grow away from the skin edge. If, however, symptoms are not settled in this way then it may be appropriate to consider surgery.

2. Surgical treatment.

A number of different procedures are available to us to treat ingrowing toe nails that have failed with non operative management. A wedge resection of the nail 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 shape, although the nail itself will be narrower.

One of the complications of surgery is recurrence. If recurrent ingrowing toe nails 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.