Ingrown toenails or onychocryptosis, is a common occurrence across all age groups. Patients usually present with moderate pain in the affected toe. The condition can progress rapidly with or without infection and severe pain. Many patients tolerate chronic ingrown toe nails. Podiatrists are well trained in the latest surgical techniques to treat ingrown nails and can offer great pain relief permanently.
Possible causes of ingrown toenails include incorrect cutting, “picking at nails”, hyperhidrosis or sweaty feet, poorly fitting footwear, trauma (ill fitting footwear), abnormal nail shape (e.g. involuted nails), obesity, or excessive external pressure. Ingrown toenails can be hereditary.
Ingrown toe nails may be managed conservatively to a point. Cutting the nail correctly and trying to repair the growth pattern is always the first option. The use of antibiotics to reduce the infection is essential. Surgical intervention by either a partial or total nail avulsion with the use of phenol proves to be successful.
A Partial Nail Avulsion (PNA) is a minor procedure that permanently removes a section of the nail plate. Basic steps to this procedure are:
- The procedure is done using local anaesthetic, making it as pain free as possible.
- The ingrown section of nail is removed and the nail matrix/root is destroyed using a chemical procedure. This prevents the section of nail from regrowing.
- No sutures (stitches) are required, and therefore in most cases minimal pain is experienced post-operatively.
- The patient will be required to return for a couple of dressing changes.
- Healing time is rapid, with full recovery usually within 2 – 6 weeks. Closed footwear should be avoided on the day of the surgery. There is usually no need to take time off work.
Ingrown toe nail surgery is to be considered when the infection has been recurrent. Antibiotics are only for the purpose of clearing up the infected tissue that surrounds the nail. An antibiotic cannot remove an ingrown toe nail. It is a physical injury to the tissue that surrounds the nail. The toe will only settle down when the nail spike causing the infection has been removed.
There are varying degrees of ingrown toe nails. The cause of the ingrown toe nail must be established before it is surgically removed. Factors to consider prior to surgical removal are:
- How often has the incidence occurred?
- Could it have been as a result of bad cutting?
- Is it hereditary?
The decision to have a surgical removal of a nail will be dependent on the answers to the questions. The age of the patient is very important as it can be a traumatic experience for a child. Only when conservative treatment has failed is surgery to be considered and is considered a last resort.