Ingrown toenails or onychocryptosis, is a commonly encountered problem in our podiatry clinics. Patients usually present with moderate pain in the affected toe, however, with progression, infection, severe pain and even difficulty walking or playing sports can occur. A lot of people tolerate chronically ingrown nails, but this should be a thing of the past. Modern podiatrists are well trained in the latest surgical techniques to treat ingrown nails and can offer great pain relief permanently.
Possible causes of ingrown toenails include improperly trimmed nails or “picking at nails”, hyperhidrosis or sweaty feet, poorly fitting footwear, trauma (kicking sports etc), abnormal nail shape (e.g. involuted nails), obesity, or excessive external pressure. These alterations cause the nail to improperly fit into the lateral nail groove, producing swelling and inflammation of the lateral nail fold.
There are a range of treatment option including conservative nail trimming, loose footwear and antibiotics but ingrown toenail surgery, particularly surgical partial nail avulsion with phenol matrixectomy remains the definitive treatment for ingrown nails.
A Partial Nail Avulsion (PNA) is a minor nail surgery procedure that permanently removes a section of nail plate. Basic steps to this procedure are
- Local anaesthetic is skilfully administered so the procedure is pain free
- In a sterile environment, the offending section of nail is removed and the nail matrix/root is prevented from regrowing using a chemical technique called phenolisaton.
- A thick, absorbent aseptic dressing is applied and the anaesthetic will be effective for just long enough for the patient to get home comfortably and settled.
- No sutures (stitches) are required, and therefore in most cases minimal pain is experienced post-operatively
- The patient will be required to return for couple of dressing changes and a final check, normallay at 24 hours post-op and then at one week.
- Healing time is rapid, with full recovery usually within 3 – 6 weeks. Closed footwear should be avoided on the day of the surgery, but there are few other side effects. Most people can return to work the following day.In nearly all cases, only one edge of the nail needs to be removed.
- In most cases, we only need to remove one edge of the nail. Once the toe is healed the toenail simply looks slightly narrower, and it can be difficult to tell that there has been any surgery.
In more severe cases, where the nail is severely deformed and causing pain on both edges of the toe, we may recommend a Total Nail Avulsion (TNA) removing the entire toenail to achieve the best result.