The Management of Ingrown Toenails

Ingrown toenails are a common condition in which the corner or side of a toenail grows into the soft flesh. The result is pain, redness, swelling and, sometimes, an infection. Ingrown toenails usually affect your big toe.

Often you can take care of ingrown toenails on your own. If the pain is severe or spreading, your doctor can take steps to relieve your discomfort and help you avoid complications of ingrown toenails.

If you have diabetes or another condition that causes poor blood flow to your feet, you’re at greater risk of complications of ingrown toenails.

Ingrown toenail symptoms include:

  • Pain and tenderness in your toe along one or both sides of the nail
  • Redness around your toenail
  • Swelling of your toe around the nail
  • Infection of the tissue around your toenail

It is important to seek medical advice when you:

  • Experience severe discomfort in your toe or pus or redness that seems to be spreading
  • Have diabetes or another condition that causes poor blood flow to your feet and experience any foot sore or infection

Common ingrown toenail causes include:

  • Wearing shoes that crowd your toenails
  • Cutting your toenails too short or not straight across
  • Injuring your toenail
  • Having unusually curved toenails


Left untreated or undetected, an ingrown toenail can infect the underlying bone and lead to a serious bone infection.

Complications can be especially severe if you have diabetes, which can cause poor blood flow and damage nerves in your feet. So a minor foot injury — a cut, scrape, corn, callus or ingrown toenail — may not heal properly and become infected. A difficult-to-heal open sore (foot ulcer) may require surgery to prevent the decay and death of tissue (gangrene). Gangrene results from an interruption in blood flow to an area of your body.

Treatments and drugs

  • Lifting the nail: For a slightly ingrown nail (redness and pain but no pus), your doctor may carefully lift the ingrowing nail edge and place cotton, dental floss or a splint under it. This separates the nail from the overlying skin and helps the nail grow above the skin edge. At home, you’ll need to soak the toe and replace the material daily.
  • Partially removing the nail: For a more severe ingrown toenail (redness, pain and pus), your doctor may trim or remove the ingrown portion of the nail. Before this procedure, your doctor may temporarily numb your toe by injecting it with an anesthetic.
  • Removing the nail and tissue: If you have the problem repeatedly on the same toe, your doctor may suggest removing a portion of the nail along with the underlying tissue (nail bed). This procedure may prevent that part of your nail from growing back.
  • Your doctor may also recommend using topical or oral antibiotics, especially if the toe is infected or at risk of becoming infected.

Various procedures for treatment of ingrown toenail:

When you attend for your consultation the surgeon may discuss one of these procedures depending on which one is the most appropriate treatment for you.

Nail avulsion – removing your whole toenail and usually the toenail will regrow.

Wedge excision – removing part of your toenail where it is growing into the skin, along with the area of tissue in the corner that your toenail grows from. Your toenail will regrow but will be narrower than before.

Nail-bed ablation – removing part of your toenail or your whole toenail and then applying a chemical (usually phenol) or an electric current to the area of tissue that your toenail grows from. This will prevent your toenail from growing back in the area that was treated.

Zadek’s procedure – removing your whole toenail and then cutting away the area of tissue that your toenail grows from. This will prevent your toenail from growing back.

Complications of surgery

  • Pain
  • Bleeding
  • Scarring
  • Infection – the surgical site – 1:8;
    the underlying bone (osteomyelitis) – 1:100

Post op care:

  • Depending on the type of procedure you have had will determine whether you will just have a dressing or sutures and a dressing.
  • You will be given instructions post-operatively on what pain relief to take, how long to leave the dressing in place, what to do when the dressing is removed and when to return for removal of stitches, etc
  • Our nurse will give you a call at home in the post-operative period to check your progress and Prof Memon is always available by phone should you need assistance out of hours.

Important Fact

An ingrowing toenail can occur again and may require further surgery!!