Ingrown Toenail Removal
Ingrown nails occur when a nail fold grows into the skin instead of growing over the skin. The medical term for the condition is onychocryptosis. The problem occurs most often in the big toe and the toenails, but it can also happen in the fingernails. Ingrown toenails are uncomfortable and can cause toe pain, preventing you from living an active life. Keep reading to learn more about treating ingrown toenails at home as well as getting ingrown toenail treatment at a doctor's office.
Appearance and symptoms of ingrown toenails
Appearance
An ingrown nail occurs due to pressure from the nail edge growing into the skin of the toe. It involves the top corner or side of the nail fold which grows into the adjoining flesh. Ingrown toenails have the appearance of skin folding over the nail. The sharp end of the nail presses into the flesh on one or both sides. Once the nail breaks through the skin, it causes pain and inflammation.
Symptoms
The most common symptoms of an ingrown toenail are toe pain, tenderness, swelling, and hardness. An ingrown nail can progress into an infection with symptoms such as redness, pain, bleeding, and pus oozing from the site, along with fever and shivering. You should seek medical care as soon as possible if you have any signs of infection.
What is the best way to get rid of an ingrown toenail?
Many people with ingrown toenails can benefit from home remedies. However, home remedies are not advisable if the nail bed is infected. You can find more information about home treatment under the section for alternative treatments below. If conservative treatments do not work, you should seek care from a podiatrist, a doctor who specializes in foot conditions.
What is the best way to cut an ingrown toenail?
It may be possible for you to carefully cut the ingrown skin edge of a toenail with nail clippers at home. If you do this, be sure to cover the toenail with petroleum jelly or an over the counter skin ointment. Also, cover the toe with a bandage to keep it clean and protected while it grows out. If you are not confident about cutting the nail yourself, a doctor can do it for you.
Can I remove an ingrown toenail myself?
As noted, you can try carefully trimming an ingrown toenail at home with a pair of nail clippers. However, any type of bathroom surgery is not advisable as it can lead to infection of the nail fold and toe.
Do ingrown toenails go away? What will happen if you leave an ingrown toenail untreated?
Ingrown toenails do not go away on their own. Without treatment, you could develop complications and permanent damage to the nail. Also, the problem can recur if it is not treated properly by a podiatrist.
It is worth trying conservative treatments and home remedies first. If they do not work, however, you should seek medical attention for your ingrown nail. A doctor will obtain all your health information and determine what is causing the problem with your toe. This is important to treat the problem effectively.
As noted, without ingrown toenail treatment, you can develop complications. For example, if your ingrown nail is the result of stress on the toes due to running, the skin edge growing over the nail can lead to permanent changes and more severe problems. You could end up having continued pain and swelling and may develop an infection of the nail bed.
A doctor can examine your toe and prescribe antibiotics if the nail is infected. They may also lift the nail with a splint to help it grow in a new position over the skin.
People with diabetes and numbness in the toes due to other conditions should be especially careful. Delaying ingrown toenail treatment can lead to serious complications in such individuals. Potential complications of an untreated ingrown nail include foot ulcers, bone infection, gangrene and limb amputation (rare).
What is ingrown toenail surgery?
If home remedies and conservative treatments do not work or the ingrown toenail problem is recurrent and chronic (long lasting), your doctor may recommend nail surgery to remove the toenail. Toenail removal surgery may also be recommended in people with diabetes who are at a higher risk of complications. The procedure is usually performed in a podiatrist's office.
Various types of toenail procedures can be performed for nail removal. Your doctor will discuss treatment options with you during your initial appointment. Surgical treatment for ingrown toenails includes temporary removal of the nail border or detachment of the nail border - this is known as nail avulsion. The doctor can also perform permanent removal of the nail border (partial matrixectomy) and permanent removal of the entire nail (matrixectomy).
Matrixectomy is recommended in patients with recurrent and persistent problems with ingrown toenails. During the procedure, the doctor destroys the nail matrix at the base of the toenail under the skin. This is the area of the nail bed from where the nail grows. The destruction is achieved either through surgical dissection or by chemically or electrically destroying the nail matrix.
Ingrown toenail removal procedure
Removal of the nail edge during a nail avulsion procedure does not require anesthesia. Matrixectomy is done under local anesthesia, which numbs the nail bed and toe. The anesthetic injection can be somewhat painful, but once the numbing medication takes effect, you will be comfortable throughout the procedure.
The doctor will perform the procedure by putting a wedge under the nail to hold up the section that is ingrowing. They will use tools like scissors to separate the nail from the bed, make a cut in the ingrown portion, and remove that section of nail to perform a wedge resection. The entire nail may be removed if both sides are affected.
To perform a matrixectomy, the doctor may use an electric device called a cautery to burn the granulation tissue or an acidic solution like TCA or phenol to disrupt the nail matrix. This prevents bleeding. However, the nail does not regrow from the part that was cauterized or treated with acid solution. Therefore, it can look different (slightly narrower) than it was before surgery.
Ingrown toenail surgery aftercare
The doctor will apply petroleum jelly and/or antimicrobial cream to the toe and cover it with a bandage after the procedure. You should keep the foot elevated for one day. The dressings usually come off the day following the toenail removal surgery.
Your doctor will advise you about cleaning the wound by soaking it in Epsom salts or with antimicrobial soap and water. You will be asked to apply an antimicrobial cream and Band Aid for 1-2 weeks to prevent infection and protect the wound while the toe heals. You may also be prescribed oral antibiotics.
It is recommended that you wear open toe or wide toe box shoes to avoid putting pressure on the wound. Your doctor will ask you to return for followup in a few weeks to check if the wound is healing properly.
Ingrown toenail surgery prognosis
If the nail matrix is left intact, the toenail usually regrows with the original width and appearance. If a permanent resection is performed (matrixectomy), the nail can appear a few millimeters narrower at the affected border. However, the overall appearance is not significantly different unless a large portion of the nail was removed during the surgery.
Possible complications
Toenail removal surgery is quite safe and complications are rare. However, problems do occasionally occur and can include persistent tenderness at the surgery site. Slow healing of the wound is another potential complication, especially in people with diabetes. Recurrence of the ingrown toenail is possible after surgery. You should follow your doctor's instructions to avoid complications. If they do occur, most complications are fairly easily managed.
Does ingrown toenail surgery hurt?
The procedure is performed under local anesthesia and you will not feel any pain during the surgery. You may experience some discomfort during the recovery period after the anesthetic wears off. Your doctor will prescribe over the counter medications for pain relief to be used as needed.
Alternative treatments for ingrown toenails
Soaking in warm water
You can try soaking your feet in warm water for up to 20 minutes 3-4 times a day to reduce tenderness and swelling. Be sure to wipe your feet thoroughly after soaking them in water. Avoiding dampness and sweat and keeping your feet dry is important to prevent toenail infection.
Placing a wedge
You can try putting a wedge of cotton or dental floss under the nail edge to lift it as it grows. Remember to change the cotton out daily if you do this. You should apply a bandage to protect the toe.
Wearing comfortable shoes
Avoid wearing heels while the toenail heals. Wear comfortable shoes that give your toenail enough room to heal.
Pain medications
Over the counter medications like ibuprofen or acetaminophen can help with swelling and tenderness symptoms.
How to maintain toenails to prevent ingrowing
Cut your nails properly
An ingrown nail is more likely if you cut your nail too short or round the nail edges instead of trimming straight across. You can reduce your risk of developing ingrown toenails by trimming your nails properly. Don't cut your nails too short. Cut straight across - don't cut down the corners of the nails.
Practice good foot hygiene
Avoid overly aggressive pedicures that can injure the nail. Maintain good foot hygiene and keep your feet dry as much as possible. Warm, moist environments are breeding grounds for fungi and bacteria. In people with ingrown toenails, the nail border can cause a break in the skin, allowing the germs to invade the area, leading to paronychia (infected ingrown toenail).
Wear well-fitted shoes
People who participate in activities like ballet, running, and soccer that put repeated stress on the toes are at risk of developing ingrown toenails. Also, athletes are prone to developing ingrown toenails because their feet perspire excessively, causing the skin to be soft, making it easier for the nail to pierce the soft skin. Injuries to the toe such as jamming or stubbing it against something can also lead to this problem. Wearing well-fitted shoes is important during sporting activities. Ill-fitting shoes can press the nail against the skin and cause ingrowing.
Get prompt treatment
There is believed to be a genetic component as well. Your chances of having ingrown toenails is higher if people in your immediate family have them. Congenital nail fold hypertrophy is a condition that is usually identified at birth and involves severe ingrown toenails. It sometimes resolves spontaneously but may require surgery. Some individuals have nails that naturally curve inwards (these are called pincer nails) and they can easily become ingrown. If you are prone to getting ingrown toenails, get proper and timely treatment from a doctor to prevent recurrences.
Finding a provider for ingrown toenail surgery
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