|
Patient
Advice and Information
Ingrown Toe Nails [IGTNs]
by Dr Panayiotopoulos, Consultant Vascular and General Surgeon
Essex.
1. What is an
ingrown toe nail [IGTNs]?
Ingrown toenail results when a nail grows into the
toe flesh and it is one of the more common foot problems.
Usually it is the big toe, however, any toe can be affected
and sometimes both feet get the problem.
2. What symptoms do they cause?
·  They
can be very painful and is aggravated by wearing shoes,
particularly those with a narrow front. May be sensitive to any
pressure, even the weight of bed cloths.
· Some
ingrown toe nails are chronic, with repeated episodes of pain
and infection. In most of them a granuloma [redundant soft
tissue] develops along the nail margin.
· Infection
is quite common, with redness and swelling. There may be drainage of
pus or a watery discharge tinged with blood.
3. What is the cause of IGTNs?
·
Improper trimming of toe nails.
·
Tight
fitting shoes that compress the toes together.
·
Hose
or socks that are too tight.
·
Abnormally shaped nail plate.
·
Trauma to the nail or the toe, even minor, especially if they are
repeated.
·
Improper motion of the joints of the feet.
·
Sometimes heredity.
4. What can I do to help?
You should cut the toe nails straight across,
leaving them slightly longer than the edge of the toe Be specially
careful at the corners avoiding tears at the nails as the will rip
down into the corner where the nail meets the skin.
Wear well fitted, moderately to low heel
shoes.
If discomfort develops try soaking the foot in
a basin of warm water 2-3 times a day.
Visit a chiropodist who may trim a small spicule of
the nail plate to relieve pressure and
elevate the end of the nail.
Apply antiseptic [i.e. iodine] below the nail
edge and along its sides. If infection occurs, you should ask for
professional attention as antibiotics and special soaks will be
needed.
If you are diabetic or have poor arterial circulation
you should never attempt to treat IGTNs at home.
5. What about treatment in chronic or
infected IGTNs?
Surgery is often needed
to ease the pain and remove the offending nail; occasionally it has
to be performed to treat the infection. In the majority of the cases
only a small portion of the nail may be removed. If the entire nail
is affected or there is severe nail deformity, the nail plate and
matrix [the cells that grow the nail] may be completely removed.
With surgery re-growth will be prevented in
85-90% of the cases.
6. How is surgery
performed?
Toenail surgery is usually carried
out under local anaesthetic, but can also be done under general
anaesthesia if required. It is usually performed as a day case.
Day case surgery means that after surgery, when you recover from
anaesthesia [3-4 hours if general, 1-2 hours after local anaesthesia]]
your escort will take you home, with all instructions given to you
before [by the surgeon] and after surgery [by the nursing staff].
a.
Coming into hospital
You will be received in the ward
by the nurse who will note your personal details and ask
about any other conditions you suffer from. You will also be visited
by the surgeon who will perform your operation and you will
be asked to sign a consent form that the procedure has been
explained to you and you agree to go ahead.
b. The
operation
As local anaesthesia has many advantages, it is the
preferred method.
 The
procedure site will be washed. Sterile drapes will be placed over
you to guard against infection and local anaesthetic will be
administered on the base of the toe. It will last for two hours or
more.
An incision is made on the affected side removing
about one quarter of the nail. [wedge excision]. The nail bed
is then removed along with any enlarged tissue or granuloma that has
developed. After removal, the nail root, bed and matrix are
destroyed by phenol [a chemical that stops cell re-growth],
heat [surgical diathermy] or surgical removal.
 Complete
removal of the
nail, the nail plate and matrix is performed only rarely, and is
preferred in fungal infections.
No stitches are necessary. The surgeon will apply a
dressing to your foot after the operation and when you recover you
will be ready to go home.
7. What about care after surgery?
·  Most
people experience little pain immediately following nail
surgery and during the healing process, which takes 3-6 weeks.
However, it is advisable to take some painkillers for the first 2
days.
· You
should not remove the dressings for the fist 48 hours
following surgery. Some bleeding may be seen immediately after
surgery, but it is rarely significant.
· You
should elevate your leg for the first 24 hours; this helps to
reduce pain and swelling.
· When
the dressing is removed, it is better to leave it open. Some
discharge from the treated area is common, as it follows the healing
process.
· Daily
soaking in saline solution
is useful as it speeds healing.
· Antibiotics
are not required, unless the toe becomes swollen, tender and red [inflammed].
· Most
patients do not restrict their normal activities at all following
partial toenail removal.
8. How will my nail look after
surgery?
After healing, following partial nail removal, the
nail will be normal in appearance, somewhat smaller. The incurvated
nail border is gone, leaving a toenail unlikely to ingrow again.
After surgery for compete removal, the body generates
a hardened skin covering over the sensitive nail bed. When this
covering has developed fully, normal activities may be undertaken.
Women can also use nail polish in this area.
Return to top of page.
Please note:
A written referral from a general practitioner is helpful but is not essentially required in order to make an appointment to see a consultant specialist. |
