By Davan 
What is an ingrown or ingrowing toenail?
Many people think they have ingrowing toenails when in fact what they have are involuted (curved) or thickened nails.
Involuted nails are nails which don’t sit fairly flat on the top of the toe. They curve on both sides forming a curled nail which pinches the skin. The sides can almost meet, forming a tube. These nails are very difficult to manage and can be very uncomfortable down the sides. The temptation is to cut the nail away to give some relief. This relief will only be temporary as the skin quickly fills in around the remaining nail resulting in the return of the original problem. The more you cut away the greater the risk of leaving a spike of nail and then your involuted nail has become an ingrowing nail.
Involuted, or pincer nails, can be hereditary and you may find other members of your family have the same type of nail, or they may curve due to systemic illness such as diabetes, biomechanical issues (the way you walk) or ill-fitting footwear and socks and tights, sports and occupations which use the toes to kick, like rock climbers and carpet fitters.
Thickened nails can be part of the aging process, systemic disease, fungal or yeast infection, trauma caused by a single injury such as dropping something heavy on the toe or repeated minor trauma from ill-fitting footwear, sports or occupation. These nails can be very uncomfortable because the thickness leads to more pressure from footwear, tights and socks and also can be crumbly and unsightly.
A true ingrowing toenail is one which a spike of nail pierces the skin. They are usually caused by poor nail cutting or trauma, but ill-fitting footwear, biomechanical factors, obesity and excessive sweating can all be contributing factors. These can be very uncomfortable, red and swollen and hot, they can become infected, producing yellow pus and smelling if left untreated. Having an ingrowing toenail is like having a splinter in your toe and until it is removed the toe will not heal.
Although we can treat ingrowing nails conservatively in clinic and get the nail to grow without any problems. Sometimes the ingrowing toenail is just too severe for conservative treatment and the only option is to remove the complete nail or the side sections of the nail and this is called nail surgery
What is nail surgery?
The term ‘Nail surgery’ can sound worrying, but it doesn’t have to be. It is a routine procedure that we use in clinic to permanently remove part, or all, of troublesome nails. It’s only a minor procedure and we carry it out using local anaesthetic.
It is used to relieve the discomfort caused by nails which may be thickened, damaged, involuted (curved) or piercing the skin. This may be all the nail or just a side section. The nail bed is treated with strong chemical, phenol, to prevent the nail growing back.
Who needs nail surgery?
Problem nails can occur in anyone for a multitude of reasons. Just to name a few they can occur because of:
- Age, due to illness, medication, poorer blood supply
- Medication, such as beta-blockers
- Health, Diabetes and under or over active thyroid can cause curved nails
- Biomechanics (the way we walk), causing nails to receive less or more pressure
- Footwear too narrow, and not a deep enough toe box
- Tight socks and tights which are too narrow, particularly support tights
- Sports, for example a rock climber banging his toes against walls and rocks
- Occupation (like a carpet fitter who uses his toes to kick carpet)
- Poor nail cutting and picking at nails
- Trauma, this could be a single blow or constant tapping in the shoe
- Fungal infection which can cause the nail to thicken and crumble
Whatever the cause these nails can be painful and unsightly and can even lead to infection.
What does removing the nail involve?
Nail surgery is a procedure we use when all other conservative treatment options have failed, or, are not suitable for your particular problem nail. At an initial appointment we would start by explaining the procedure to you and you can have the opportunity to ask any questions, we would also do a very thorough assessment of your suitability for the surgery.
On the day of nail surgery, the appointment takes about an hour, this is mostly due to the time it takes for the toe to become numb from anaesthetic. This is similar to an injection at the dentist, it just takes longer to become numb in the toe. The actual procedure takes about 20 minutes. There is very little bleeding because we use a tourniquet and the patient can either lay down or watch.
The toe is dressed, you will be given instructions on how to care for the toe and we will see you back to redress the toe after a couple of days. You will need someone to drive you home as the toe will be numb for approximately 4 hours, again similar to your mouth when you’ve been at the dentist. Once the anaesthetic wears off if you have any discomfort take some pain relief. Avoid aspirin as it can cause bleeding, however if you take it as part of your routine medication continue to do so.
We offer two levels of post- nail surgery care
- Platinum Care package – This is ‘start to finish ‘care which is carried out in clinic. Initially you will have the toe re-dressed twice a week, then once a week until the toe is completely healed. The patient will not have to do any re-dressing themselves at all. (an emergency dressing kit is also included)
- Gold Care Package – This option is for the more confident patient who is able and happy to redress at home or has a family member that is medically trained and able to care for the toe dressings. One week after nail surgery we would carry out the follow up redress appointment then you will be given everything you need to continue self-care at home. (dressing package provided)
Whichever post-surgery treatment you opt for you will be given a take home pack which will include advice on care, what to expect continuing with your normal activities and showering.
Once healed if you had a section removed off the side of your nail, it will look like normal nail just narrower and flatter.
If the whole nail is taken off the toe will be left with a slight imprint where the nail used to be.
