Nail Surgery
What are ingrown toenails?
Ingrown toenails occur when the edge of the nail grows into the surrounding skin, causing pain, inflammation, and potential infection. This common condition affects millions of people and can significantly impact daily activities and quality of life.
Why do ingrown toenails happen?
Several factors contribute to the development of ingrown toenails, often working in combination to create the perfect conditions for this painful condition.
Genetics
Many people inherit a natural predisposition to ingrown toenails through their nail shape and curvature. If your family has a history of nail problems, you may have inherited nails that naturally grow with a more pronounced curve or thickness that makes them more likely to grow into the surrounding skin. These genetic factors are often the underlying reason why some people experience recurring ingrown toenails despite proper care. It is common for ingrown toenails to be noticed in children as young as 3 years old, and they can be a problem from 8 years old.
Footwear
Ill-fitting shoes are one of the most common causes of ingrown toenails. Tight-fitting shoes that compress the toes, high heels that force toes into cramped positions, and even poorly fitting socks can create constant pressure on the nail edges. This pressure gradually forces the nail to grow into the skin rather than straight out. Many people don’t realise that shoes that feel comfortable when standing can become too tight during walking or extended wear.
Nail Care
Improper nail trimming is a leading cause of ingrown toenails. Cutting nails too short, rounding the corners, or picking and tearing at nails can all encourage the nail to grow into the skin. Many people learned incorrect nail care techniques in childhood and continue these practices into adulthood, unknowingly creating conditions for ingrown nails to develop.
Physical factors
Various physical conditions can contribute to ingrown toenails. Toe injuries or trauma can alter the nail’s growth pattern, while excessive sweating creates a moist environment that softens the skin and makes it easier for nails to penetrate. Fungal infections can thicken the nail, and biomechanical issues affecting how you walk can create abnormal pressure patterns on the toes. Additionally, people who participate in sports with repetitive toe impact or work in occupations requiring prolonged standing are at higher risk.
Signs and symptoms of an ingrown toenail
Recognising the early signs of an ingrown toenail can help prevent progression to more serious stages:
- Pain
- Inflammation
- Pus or discharge
- Bleeding around the nail edge
- Difficulty walking or wearing shoes
- Foul odour from the infection
- Formation of granulation tissue
- Difficulty sleeping with pressure from the duvet
Treatment options
We would always advise to see a podiatrist as soon as possible for any concerns about foot health because accurate diagnosis is vital to decide upon the treatment required. If you are have an ingrown toenail and need to manage the symptoms at home then the following may help
- Warm salt water soaks to reduce inflammation
- Proper nail trimming techniques
- Comfortable, well-fitting footwear
- Topical/oral antibiotics
- Pain management
When you have an appointment we will assess and discuss treatment options with you, for some people we can offer conservative care, where we regularly see you, trim the nail and clear the ingrown section and advise on footwear. Any relevant dressings are applied.
For patients with recurring, curled, or particularly painful ingrown toenails, nail surgery is most often the treatment we recommend.
Ingrown toenail surgery
Preparation and Anesthesia The procedure begins with a local anesthetic injection at the base of the toe, similar to a dental injection. This may cause only minor discomfort for a few seconds, after which the entire toe becomes completely numb.
The Surgical Process Once anesthesia takes effect, the procedure is entirely painless. The process involves:
- Cleaning the area and use of a skin antiseptic
- Applying a tourniquet to the toe to reduce blood flow
- Careful removal of either one or two sides of the nail (partial nail avulsion)
- Treatment of Phenolthe nail base to stop it regrowing
- Apply a dressing
The actual procedure lasts approximately 12-15 minutes, though the overall appointment takes around 45 minutes. This extended time ensures a relaxed environment where we can provide thorough, unhurried care and address any concerns you may have.
The key to successful nail surgery lies in treating the root cause rather than just the symptoms:
After care (individual advice varies)
Immediate Aftercare (First 24-48 Hours)
- Keep the dressing dry and intact
- Elevate the foot, when possible, to reduce swelling
- Take prescribed pain medication if required
- Avoid prolonged standing or walking
- Wear loose-fitting footwear
- Avoid activities that may cause trauma to the toe
- Keep the foot elevated when resting
Ongoing Recovery (First 2-3 Weeks)
Dressing Changes
- Salt water bath the toe
- Apply fresh dressing daily
- Keep the wound clean and dry at all other times
- Watch for signs of infection (increased redness, warmth, discharge)
- Attend all follow-up appointments
Gradual Return to Activities
- Slowly increase activity levels as tolerated
- Do not go swimming until the area has healed
- Avoid sports and high-impact activities until cleared
- Wear appropriate footwear that doesn’t pressure the surgical site
- Maintain good foot hygiene
Healing Timeline
- Initial healing: 1-2 weeks
- Complete healing: 3-4 weeks
- Full return to normal activities: 4-6 weeks
- Final nail appearance: 2-3 months
Long-term Care
- Proper nail trimming technique (straight across, not curved)
- Appropriate footwear selection
- Regular podiatric check-ups
- Maintaining good foot hygiene
- Early intervention for any nail problems
Success rates
Nail surgery performed by qualified podiatrists has excellent success rates, with 95-98% of patients experiencing no recurrence of ingrown toenails following the procedure. Patient satisfaction is consistently high, with most people reporting significant pain relief and being pleased with the cosmetic results. When proper aftercare instructions are followed, complication rates remain minimal, and the vast majority of patients experience a substantial improvement in their quality of life, being able to return to normal activities and wear regular footwear without discomfort. For even more information on ingrown nail surgery, read this blog.
To better understand the procedure, we recommend viewing the educational video below from the Royal College of Podiatrists, which demonstrates the surgical technique. Our experienced podiatrists are available to discuss any questions or concerns you may have about the procedure. If you’re experiencing recurring ingrown toenails that are affecting your daily life, we encourage you to get in touch with us here at RS Podiatry. With proper nail surgery, you can achieve lasting relief and return to your normal activities without the worry of future ingrown toenail problems.