What is an Ingrowing Toe Nail?
An ingrowing toe nail occurs when the nail of the toe grows under the skin on either side of the toe. The skin can become irritated by this, causing considerable discomfort, or can become infected.
Often, ingrowing toe nails occur because of aggressive toe nail clipping. when the toe nail is clipped back too much at the side, the skin falls over the top of the cut area and when the nail grows back, it can grow into the soft tissues at the side.
Tight shoes can push the toe nail into the skin, or an injury to the toe can split the nail plate but an abnormality of the toe nail itself can lead to ingrowing. Rarely, an abnormality of the underlying bone in the toe can cause a problem.
If you have an ingrowing toe nail, there are a variety of specialists who may be able to offer you treatment. Your chiropodist or podiatrist may be able to offer you advice and simple therapies to prevent ingrowing toe nails forming. If the ingrowing toe nail recurs, or never really settles, you should see and orthopaedic surgeon who specialises in foot and ankle surgery. If you have an infection, antibiotics will help to settle this down, but surgery is often required if you have had an infection. X rays are sometimes required, if there appears to be extra bone forming under the toe nail, but you will be advised on this by your specialist.
How is the Surgery Performed?
Ingrowing toe nails can be dealt with in several ways. If the affected part of the nail is only on the side, then a wedge excision can be performed. This removes a part of the nail, and more importantly, the tissue underneath where the nail grows from. This is done by cutting and also by applying a chemical to prevent re-growth of the nail.
If the nail has already had this treatment, or there are other problems, then the nail can be completely removed and the whole area where the nail grows from is removed surgically and then a chemical applied to kill any remaining cells capable of producing a new nail.
Surgery is carried out under general anaesthetic, but can be carried out with local anaesthetic injections behind the knee or around the ankle. The injections are normally given while you are asleep for your comfort. They can give good pain relief for the first day after the operation. You can go home the same day in the evening but should keep the foot highly elevated to prevent bleeding.
Risks of Surgery
Bleeding, infection, poor skin healing, recurrence, and a need for further surgery.
There is a small risk of blood clots in the legs or lungs (DVT and PE), and there are also risks from anaesthesia – the process of being put to sleep for your operation.
Risks of Anaesthesia
The injection behind your knee is given using an ultrasound machine to guide the needle. There is a less than 1% chance of injury to the nerve. General anaesthetic also carries risks. These risks are proportional to your general health. You will need to be assessed for your fitness for surgery and an Anaesthetist will be able to advise you on your individual risk.
You will have had injections to numb your foot so that you are not in pain after the operation. This injection will wear off after 18-24 hours, so you must take regular painkillers so that you are not in severe pain when the injection wears off.
The pain will settle over a few weeks. You may see blood stains on the dressings. This is normal and not a cause for alarm.
The toe can bleed a lot after toe nail surgery. You should keep your foot elevated above the level of your heart as much as possible after your operation, as letting the foot hang down may cause further bleeding. If blood is dripping from the dressings continuously, then return to hospital. Do not remove or change the dressings if the toe is bleeding – this will make it bleed more.
If you are resting on your sofa, keep your foot elevated on the back rest or arm rest. If you are resting in bed, then place a few pillows under the foot to keep it elevated.
The foot will be swollen as well as sore for a few weeks. You should keep the foot elevated as much as possible for the first two weeks. Keep walking down to a minimum – going to the toilet or for meals. Letting the leg hang down will cause the foot to become more swollen.
You have been given a special shoe that is for your comfort while walking, as you will not be possible to get into a normal shoe with heavy dressings applied. This will be reduced to a light dressing after two weeks. Crutches are for balance only.
There are no particular exercises to be performed for the toe, but drawing the alphabet in the air with your foot will keep all the joints mobile.
RETURNING TO WORK
After two weeks, you will be seen in the clinic and the stitches will be removed. I advise that you do not return to work before this, especially if you are on your feet all day at work. The wound may remain moist for a few weeks and this may require dressings. When it is dry, you can return to normal shoes and return to work. This is normally within a few weeks of the operation. Remember that not everyone is the same, and some people take a longer time to recover from their surgery. Please request a sick note before you leave hospital, if you need one.