Ingrown Toenail Treatment
An ingrown toenail is one of those problems that sounds trivial until you have one. It hurts when you walk. It hurts when a duvet touches it. It throbs at night. And it very rarely gets better on its own, because the thing causing it, the edge of the nail, is still there.
It is also one of the most reliably fixable problems in medicine. In most cases, permanently, in a single visit.
What is actually happening
The edge of the nail has started pressing into the soft skin at the side of the toe, the nail fold. Skin reacts to anything sharp pushing into it by becoming red, swollen and sore. If the nail breaks the surface, bacteria get in and the fold becomes infected. The swelling then presses harder against the nail, which makes it worse rather than better. The clinical name is onychocryptosis.
Almost always it is the big toe, and almost always one side of it.
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Why they happen
- Cutting the nail down the sides instead of straight across. The single most common cause. It leaves a spur of nail buried under the skin that grows forward into the flesh.
- Tight or narrow footwear that squeezes the toes together, and shoes that are too short so the toe is pressed against the end.
- Sport. Running, football, hiking and anything with repeated toe-to-boot impact.
- Sweaty feet. Moisture softens the nail fold and makes it easier for the nail to cut into it.
- The shape of the nail. Some people simply have a more curved nail, and the curve does the rest.
- An old injury to the toe that changed how the nail grows.
When to get it seen
Come in if any of these apply:
- It has been sore for more than a week and is not improving
- The side of the toe is red, swollen or warm
- There is any discharge, or proud flesh growing over the nail edge
- It throbs, or it wakes you at night
- It has happened on the same toe before
- You have already had antibiotics for it and it came back
That last one matters more than people realise. Antibiotics treat the infection, not the cause. If the nail edge that caused the infection is still in place when the course finishes, the infection has somewhere to come back to. That is how people end up on their third or fourth round of antibiotics for the same toe.
See a doctor urgently if the redness is spreading up the foot, if you have a fever, or if you have diabetes, poor circulation or a condition affecting your immune system and the toe becomes infected. Those need same day attention, not an appointment next week.
Your options
Conservative nail care, no surgery
For a first episode caught early, where the nail edge can still be freed without surgery. The offending spur is removed, the fold is cleaned, and the nail is given the chance to grow out over the edge instead of into it. Quick, sterile, and it relieves the pain immediately. It is the right first answer for a lot of people and we will say so when it is.
More on conservative nail care
Partial nail avulsion
The permanent option, and the right one if this has happened before or if the fold is chronically infected. The toe is numbed. A narrow strip is removed from the problem side of the nail, all the way back to its origin, and the small area of matrix that was producing that strip is treated so that edge does not grow back. The rest of the nail is untouched.
This is the procedure with the track record. In the published literature, partial nail avulsion combined with treatment of the matrix has consistently lower recurrence than simply removing the nail edge, which is exactly why we treat the matrix rather than cutting the spur out and hoping.
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Total nail avulsion
Reserved for toes where the whole nail is the problem, not one side of it. Less common, but occasionally the right call.
Does it come back?
If the matrix is treated, that edge does not regrow, so it cannot ingrow again. No honest clinic will tell you the recurrence rate is zero, because no procedure anywhere has a zero rate. But this is the procedure specifically designed to be the last one you need on that toe, and that is how we use it.
If you have had a nail edge cut out before without the matrix being treated, and it came back, that is not bad luck. That is what happens when the matrix is left in place.
What the appointment involves
- We look at the toe and talk through what has been happening, including anything already tried.
- We agree the approach, conservative or surgical, and what it will cost, before anything is done.
- If you are having surgery, the toe is numbed. This is the only part that stings and it passes in seconds.
- The procedure takes about 20 minutes.
- The toe is dressed and we go through aftercare with you properly before you leave.
The whole appointment is booked for 40 minutes so none of that is rushed. In the great majority of cases you are treated on the same visit, which matters if you have travelled.
Aftercare
You will be given specific instructions for your toe. In general terms: keep the dressing clean and dry, wear a roomy shoe for a few days, use ordinary pain relief if you need it for the first day or two, and avoid soaking the foot until we tell you it is fine. We will tell you what normal healing looks like and what would be a reason to ring us.
Common questions
Can I just leave it and hope it settles?
A very mild first episode sometimes does settle. Once the fold is infected, or once it has happened more than once, it usually does not, because the nail edge causing it is still there.
Will I lose the whole toenail?
Almost certainly not. Partial nail avulsion removes a narrow strip from one side. The nail you see afterwards is your own nail, slightly narrower on that edge, and most people never notice.
Can I drive home?
Only the toe is numbed and you are not sedated, so most people drive home without difficulty. Bring a roomy shoe or an open sandal.
When can I run again?
Longer than walking, and it depends on the toe and the procedure. Tell us what you do and we will give you a straight answer rather than a stock one.
Do I need a referral?
No. You can book directly.
Will my private health insurance cover it?
This depends on your individual insurance policy. If you have extras containing podiatry cover, it is likely a portion of the fee will be covered.
What does it cost?
We give you the full price at the consultation, before anything is done, and it does not change afterwards. It is one all-inclusive fee covering the consultation, the local anaesthetic, the procedure, dressings and your aftercare.