Saturday, April 13, 2024
FOOT HEALTH Skin and Nail Problems

Ingrown Toenail Surgery: The Surgical Procedure and What It Entails

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What Is an Ingrown Toenail?

An ingrown toenail arises when the edge of the nail pinches into the surrounding skin, which often leads to symptoms like pain, swelling, and redness. Constant irritation of the skin near the nail can heighten the discomfort, particularly while walking.

Over time, this can develop into an infection that can rapidly escalate. In these situations, an ingrown toenail surgery is needed.

While ingrown toenails predominantly affect the big toe, they are not exclusive to it and can manifest in any toe.

Chronic instances of ingrown toenails can turn into a substantial problem and should be addressed promptly to avoid further complications.

close up hand clipping toenail

What Causes Ingrown Toenails?

Ingrown toenails are a common condition with multiple possible causes. Factors that can contribute to this condition include:

  • Cutting your nails too short
  • Digging into the corners of your nails when trimming
  • Cutting your nail edges in a round manner
  • A family history of ingrown toenails
  • Tight-fitting shoes and socks that impinge on the nail borders
  • Trauma to the nail (such as having your nail stepped on and impacted into the underlying tissues)
  • Prior nail removal, as this can cause regrowth of a deformed nail and thus cause impingement
  • Repetitive pressure on the nail from certain sports/dance
  • Fungal nail conditions that cause the nail to become thick and ingrown 
  • Thickness and curvature of the nail that can occur with age
cutting nails straight

How Can You Prevent an Ingrowing Nail?

Preventing an ingrown toenail largely involves adopting healthy habits. Consider the following suggestions to keep this common problem at bay:

  • Make sure you cut your nails straight across! Do not cut them in a rounded shape, as this places you at a higher risk for nail impingement. 
  • Avoid cutting nails too short. Let your nail grow out past the edge of the toe before trimming the nail straight across.
  • Soak your toe in Epsom salts daily to keep the area clean and help with achiness in the toe.
  • Use adhesive tape to tape your swollen skin away from the nail daily until your nail edge grows out.
  • Try stuffing a small amount of cotton between the edge of your nail and nail border to prevent impingement until the nail grows out.
  • Wear comfortable shoes that do not put direct pressure on the toes. Avoid high-heels.
ingrown toenail removal

Types of Ingrown Toenail Surgeries

Slant Back Procedure Toenail

This method can be done when there is a small piece of nail at the edge of the toe that is impinging against your skin. This method rarely requires an anesthetic and is usually performed for a painful ingrown toenail that is not infected. 

A small vertical piece of nail is cut from the affected ingrowing nail allowing relief of impingement. This usually requires no significant aftercare and will provide patients with immediate relief. 

Matrixectomy

If the ingrown nail becomes infected, or a prior slant back technique has failed, a matrixectomy should be performed.

This is a very common intervention that can be done in the office setting. It requires an injection of a local anesthetic to numb the toe.

There are 4 nerves in each toe, so all 4 nerves must be numbed up with an injection. Usually, an anesthetic called Lidocaine is used. This will keep the toe numb for up to 2-3 hours.

So does the numbing injection hurt? Yes, the numbing injection may be slightly uncomfortable, but your doctor can apply a numbing cream onto your skin prior to injecting the anesthetic to keep you more comfortable.

The numbing cream that is often used for an ingrown toenail removal is called Lidocaine/Prilocaine (EMLA). 

Then when the toe is numb, the corner of the ingrown nail is excised from the tip of the nail to the base. 

Check out this video of an ingrown toenail.

To ensure that the nail border won’t grow back, a chemical acid called Phenol is used to burn the nail matrix (the area beneath the cuticle which produces nail-creating cells). Antibiotic ointment is applied to the toe as well as a thick bandage. 

Winograd Surgical Procedure

If you have already undergone repeat matrixectomy treatments and the ingrown toenails keep growing back, your doctor may perform a Winograd procedure

The doctor will numb up your toe, and perform an excisional wedge resection of the ingrown toenail, adjacent skin tissue, and nail matrix. Once removed, the remaining area would then be repaired using stitches.

You may notice more scarring with this treatment, but it is very effective because the nail root is excised causing no opportunity for the ingrown toenail to grow back.

Sutures would be removed 2 weeks after the surgery. 

Permanent nail removal stages

Permanent Surgical Removal of the Nail

If you experience chronic ingrown toenails along the medial or lateral nail with chronic infection, you may want to consider permanent nail removal. This would also be an acceptable treatment option if you have one or two toenails that are very thickened, heavy, and painful. 

Your doctor will numb up your toe with an anesthetic and then remove your whole nail. Then, they will use phenol to cauterize your nail matrix to prevent a new nail from growing back. 

Your toe may drain for several weeks, as this operation is aggressive, and you will need to be closely monitored.

Eventually, the nail bed will heal up revealing an absent nail.

Temporary Avulsion of the Nail

In the case of a nail root infection, or if you have a loose nail due to trauma, your doctor will recommend a “temporary” nail avulsion. This is when the nail is simply removed without the use of phenol. This allows for a new nail to grow back.  

Keep in mind though, that if you have your toenail removed, it will take up to 12 months for a new nail to grow back. Also, the new nail will be slightly thicker.

It may feel odd to not have a toenail. You will need to keep your toe protected in shoes that have a stiff toe box to prevent injury to your toe while the nail is growing back.

Post-operative Care

You will need to change your bandage daily. First apply antibiotic cream onto the treatment site, along with non-adherent gauze. Then wrap the toe using rolled gauze. You will need to do this the first few days until the drainage reduces.

Your doctor will provide you with post operative instructions as well as information about what you can expect during the recovery process.

Make sure to read the information given thoroughly to ensure a good recovery.

You can buy a kit with all dressing materials included here.

Most people will need to limit their activities for a day or two, and take over-the-counter anti-inflammatories such as Motrin if they experience pain. It is okay to shower the same day of your ingrown toenail surgery.

Avoid high-impact activities like running, for about two weeks. 

Ingrown Toenail Scab

Eventually, the surgery site will become dry, and the scab will fall off, revealing a natural-looking thinner toenail. 

What Is the Recovery Time After the Operation?

Recovering from ingrown toenail surgery typically involves a brief healing period. Generally, the wound starts to heal within a few weeks.

However, the exact recovery time can vary from person to person, contingent on factors such as the severity of the condition, the specific therapy performed, the patient’s overall health, and their body’s natural healing response.

While minor discomfort may persist for a couple of days post-surgery, full recovery and return to regular activities often take place within two to four weeks.

Most children who undergo the treatment can return back to school the next day.

Complications

Like any intervention, ingrown toenail surgery carries potential complications. Some of these complications include:

  • Infection
  • Continued pain
  • Numbness in the toe/tingling pain
  • Deformed toenail
  • Recurrence of ingrown toenail and need for more aggressive surgery
  • Gangrene if the patient has a poor blood supply and cannot heal the site

Cost 

The cost of the treatment can vary significantly depending on various factors. These include the complexity of the case, the specific type of therapy required, the surgeon’s fees and geographic location of the healthcare provider. Furthermore, whether or not the intervention  is covered by insurance, and to what extent, can also influence the out-of-pocket expense.

In general, the procedure costs $300-$600. 

At What Point Should You Seek Professional Medical Attention at a Foot Health Clinic for an Ingrown Toenail?

You should consult a medical professional if you notice persistent pain, inflammation, or signs of infection such as redness, warmth, pus, or increased swelling. If home remedies and self-care measures aren’t providing relief, or if the condition is worsening despite your efforts, a visit to a podiatry clinic is crucial.

healthy toenails

Conclusion

Your  toenails, a crucial body part, perform an essential role – they provide protection to your toes. Avoiding the necessity of toenail surgery for ingrowing toenails is always more desirable. However, every year, thousands undergo this medical surgery to alleviate the discomfort and infection that result from this condition. These modern medicine techniques have been pivotal in managing this common foot-related issue.

Should you suspect that you might need such an intervention,  it is crucial to promptly reach out to your healthcare provider. This step is vital in ensuring you receive the correct medical advice and education related to your health care, ultimately guiding you towards the most appropriate treatment.

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Photo Credits:

Pedicure photo created by freepik – www.freepik.com

Manicure and pedicure photo created by valuavitaly – www.freepik.com

Disclaimer: The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition or treatment before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Vaishnavi Bawa
Dr. Vaishnavi Bawa is a Podiatrist who specializes in treating foot and ankle pathology. LifesLittleSteps mission is to educate the public about foot health in an easy-to-understand manner using evidence-based medicine.
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