Ingrown Nail Surgery
What is an ingrown nail? Ingrown toenails (also known as onychocryptosis) is a very common condition of the feet. It is frequently seen with the big toe, but can sometimes affect the lesser toes too. An ingrown nail is caused by pressure from the nail edge on the surrounding skin. The longer an ingrown nail is left, the higher the chance of it cutting into the skin. This can then lead to localised inflammation, and potentially cellulitis (infection of the skin). In people with compromised vascular supply, or who are immunocompromised, this can sometimes quickly lead to widespread infection and potentially onychomycosis (infection of the bone) Ingrown nails can become quite debilitating and limit types of footwear you can wear. Common causes of ingrown nails are, · Incorrect nail cutting, often from cutting too short or round the edges · Aggressive pedicures · Improper/incorrect fitting footwear · Toenail injuries, such as stubbing your toe or dropping a weight on the nail · Certain nail polishes, as the excess weight of the nail polish can cause soft, weak nails to grow down · Nail fungal infections, as the fungus causes the shape of the nail to change · Wide nail plates · Naturally curved nails, or weak nails · Nail picking · Subungual exostosis, which is a benign bone tumour under the nail plate that pushes up and causes the nail to change shape Treatment of ingrown nails at Mount Lawley Physio and Pod is possible! If infection is present (inflammation, redness, pus and blood exudate), you must consult a GP immediately for a course of antibiotics. At home, it’s best to soak the toe with a mix of salt and warm water for 10-15 minutes. It is also important to keep the area sterilised and dressed properly with Betadine and Band-Aid to ensure the area isn’t compromised by environmental bacteria. However, antibiotics are not a solution to ingrown toenails and merely help with the infection. Removal of the offending nail spicule is still necessary. There are 3 options for treatment by your podiatrist. Often, we can remove the offending nail spicule without any need for local anaesthetic. This is done during a normal consultation, and involves the use of a scalpel to ease the edge out. The second option is to perform nail surgery. Often if the nail has grown a long way down the edge, or is ingrown at the base of the nail, nail surgery is the best option for near permanent pain relief (there is a small re-growth rate of less than 10%). A nail operation involves injecting local anaesthetic into the toe, applying a tourni-cot and then removing the edge of the nail. This generally takes an hour to perform, and we then aim to stop the spicule from growing again by applying a caustic agent called phenol. The third option is nail bracing. We are the only podiatry clinic in Western Australia to provide this option, and is best for young children, patients on anti-coagulants, people who are needle-phobic or are immunocompromised (diabetes) where surgery isn’t indicated. It involves the application of a nail brace, which has two suction cups on each end. The suction slowly pulls the edges of the nail up and out of the edge, which then allows us to remove the offending edge. The nail brace needs to be replaced every 4-6 weeks, but still allows you to play sports, work as normal and wear your normal footwear.