Ingrown Toe Nail

An ingrown toenail is a painful condition when the nail grows into the fold of the skin along the toenail. It commonly occurs in the great toe but can also occur in other toes or even in hands. The actual cause for IGTN is not known. It is often associated with tight-fitting shoes and is commonly seen in athletes and ballet dancers. A genetic predisposition, trauma and improper nail trimming are also suggested to contribute to the development of ingrown toenail. An ingrown toenail can be extremely painful. The nail fold can also get infected requiring antibiotic treatment.

In early stage and in mild cases conservative measures can be tried with varying degrees of success. These include, warm water and salt soaks, antibacterial ointment and using a gutter splint to separate the nail fold from the edge of the growing nail. Meticulous foot care is normally advised to prevent IGTN which include proper nail trimming of nail straight across instead of rounding at both corners.

Surgery provides the definitive treatment for IGTN. There are several forms of surgery available for this condition:

• Avulsion of nail
• Wedge excision of lateral and/or medial edge of the toenail
• Zadek’s Procedure.

Avulsion and wedge excision relies upon the subsequent nail growth to be normal, particularly when a cause for the IGTN is identified, such as ‘tight-fitting shoes’. This is particularly useful ‘first’ procedure for young girls and those who would like to keep their toenail. Zadek’s procedure is a definitive procedure which entails removal of the nail as well as the nail bed so that the nail doesn’t regrow and is replaced by tough scar tissue. This procedure is often combined with the ablation of nail bed with a chemical such as phenol to kill the cells that help the re-growing of the nail. Nail varnish can be applied to the scar tissue that forms in the nail bed after Zadek’s procedure. Recurrent IGTN can happen after surgery. This can be due inadequate technique, failure of ablation of nail bed or simply inherent tendency to develop IGTN. Zadek’s procedure has the lowest recurrence rate of recurrence usually mild requiring some tidying up.

Surgery for IGTN is a day case procedure that can be performed under local anaesthetic. The anaesthetic is injected in a ‘ring like’ fashion at the base of the toe. The patients are able to go home after few hours. The toe is bandaged and normal advice to keep it for 48 hours. The patient will normally require simple painkillers such as paracetamol for 48 hours following surgery. Depending on the nature of work the patient will require one or two weeks off.

The wound is checked after a few weeks following the surgery. No further follow-up is normally required if the healing is satisfactory.