General Surgery Ingrowing Toenails

This is a painful condition of, usually, the big toe but any toes can be affected.  If treatment with antibiotics and care with hygiene has not worked a small operation is usually needed.  It is often first worth trying to brush up and down in the gutter at the side of the nail every time you wash your feet.

The condition is due to infection at the side of the nail where it is embedded in the toe.  This causes inflammation, a part of which is swelling of the soft tissues.  This causes the soft tissue to spread over the edge of the nail and gives the impression of the nail having 'grown into' the tissue whereas what has happened is that the tissue has grown over the nail.

The Operation

The operation is carried out under ring block local anaesthetic (although a general is available at The London Day Surgery Centre).  A needle is inserted at the base of the toe and local anaesthetic solution is injected all round the toe so that the whole toe goes numb.  After fifteen minutes or so the anaesthetic will have worked and a thin sliver of the side of the nail can be removed together with cleaning out of all the infected tissue.  A dressing is applied and you are given full instructions about future care, change of dressings and regular foot bathing.  The nail will regrow normally over a period of a few months and you should keep the area clean and, maybe, brush in the side gutter once tenderness has completely settled.

Recovery

You will be able to go home straight afterwards or stay with us for a cup of tea or coffee or soft drink and a biscuit.  Most patients have only a little pain once the local has worn off and you may need paracetamol or ibuprofen or similar tablets for a short while.  We may give you a short course of antibiotics as well.  Complications are rare but you will be given a 24 hour telephone number in case of need.  Follow up appointments are not usually needed but can be made if necessary.

Sometimes this condition recurs and then another operation is used which leaves the nail permanently less wide.  As well as a sliver of nail being removed a wedge of the nail bed underlying it and, especially, under the hidden part at the cuticle is removed.  Stitches are then needed and these are removed after about ten days.  This operation, using the same ring block local anaesthetic, takes fifteen to twenty minutes. Prescribed pain relief will manage any discomfort after the local anaesthetic has worn off.