Predisposing factors include tight footwear(especially for long periods of time), sweaty socks, incorrect trimming of toenails(especially if curled at the sides) and poor foot hygiene.
When an ingrown toenail becomes infected, antibiotics is often required. It is best to defer surgery until the infection has subsided.
Surgery - Wedge Resection of Ingrown toenail
This involves removing the edge of the nail and its nail bed - this results in a narrowed nail.
Local anaesthesia is injected into both sides of the toe base(This may sting) The toe will feel numb in a few minutes.
A glove tourniquet is place around the base of the toe to reduce bleeding. The toenail is then excised at the side where it is ingrowing. A curette may be used to scrape out the nail bed to reduce the risk of recurrence.
Dressing - The toe bed is then dressed with Jelonet(non-stick paraffin gauze) and crepe bandage. The tourniquet is removed at the end of the case and the circulation to the toe is checked to ensure that the bandage is not too tight.
If there is a high likelihood of infection, an antibiotics will be prescribed.
It is important to ELEVATE the foot as much as possible - eg in the car on the way home and at home(The patient will need to be driven home)
Pain-killers may be required in the first few days. It is best also to not wear shoes in the first week - sandals or slippers would be better. The bandage is usually removed after 2 days - if stuck to wound, it may be best to soak in water/salt water first. After that, a simple gauze dressings can be applied to wound.
Risks of Surgery
1. The toe may swell up and because the bandage is tight - this might cause the toe to become gangrenous. It is IMPORTANT that the bandage be removed if it becomes to painful. A doctor should be immediately consulted.
2. Infection in the wound site and underlying bone - This would need treatment with antibiotics; bleeding from wound - need to apply more bandage(but not too tightly); pain
3. Recurrence - part of the nail may regrow : this will need further surgery
4. Damage to the tendons to the toe
5. Toenail will look narrower than the other unoperated toenails
Note: Mr LP Cheah sees a lot of patients with ingrown toenails. Not all patients require surgery. Wedge resections can be performed with sedation or under general anaesthesia in theatre.