What is an Ingrown Toenail?

To simplify, an ingrown toenail is the problem related to the nail of any digit, the corner of which abnormally grows towards the skin and strikes against the skin rather than growing normally above the skin and coming out over the skin. An ingrown toenail most commonly affects the nail of the great toe either on one or both sides of one or both toes.

Causes

Causes of an ingrown toenail are not known in all patients. However, the most common causes are external trauma over the toenails as happens in sports, abnormal nail pairing habits, diabetic foot infections, repeated minor injuries, very tight footwear, and sometimes prolonged walking leading to continuous and sustained minor injury over the toe tips.

Do’s and Don’ts

Do’s:
-Daily care of bilateral feet.
-Safe and proper trimming of toenails.
-Comfortable footwear.
-Consult a plastic surgeon in case of excessive pain, swelling, or redness around the corners of nails.
Don’ts:
-Tight footwear.
-Abnormal nail pairing habit.
-Repeated trauma over the toe tips.
-Conventional treatment by complete removal of toenail.

Type of surgery

Ingrown toenail surgery is a minor surgery performed under local (ring block) anesthesia.

The goal of the surgery

This surgery aims to cure the pain and prevent repeated episodes of infection at the corners of the nail.

Ingrown toenail Procedure

To achieve these objectives, local anesthesia is infiltrated around the base of the great toe, and after the digit is anesthetized completely, a tight encircling rubber band (digital tourniquet) is tied and tightened at the base to prevent the blood from entering into the digit and facilitate the surgery. However, this tight digital tourniquet is released at the end of the surgery to restore the blood supply of the digit. After tying the digital tourniquet, incision is marked at two sites if one corner of the nail is affected and at four sites if both the corners of the nail are affected. Complete symptomatic relief at the problematic corner of the nail can only be achieved by ensuring permanent cessation of nail growth at the offending site. And this requires removal of the root of the nail called nail bed (germinal matrix) along its entire length from the tip or corner of the nail to its deepest extension below the skin at the base of the nail. Thus, removal of the whole strip of nail bed along its entire length is the key step for successful surgery leading to permanent cure. And this is the reason for incisions at two sites (one at the affected corner of the nail and another over the skin at the base of the nail).

After complete removal of the entire length of nail bed is ensured, thorough wash with saline is given to remove small debris and then the incisions are closed meticulously with fine sutures. All these steps of operation are performed with fine dissection skills of plastic surgery with the use of 4 – X Zeiss loupe magnification and delicate instruments. After sutures are completed, pressure dressing is applied, and digital rubber tourniquet is released after the dressing is tightly applied.

Post-procedure instructions

The patient is instructed to have complete rest and elevate the operated leg over a pillow for at least 2 days after the surgery. The first dressing is done after 3 days, and then sutures are removed during the second dressing after 6 – 7 days of surgery. The patient can join his/her routine work after 3 days of operation. However, sports activities and running should preferably be avoided until 3 weeks after the surgery.

Why Kosmetica for Ingrown Toenail Surgery?

At Kosmetica, all patients of ingrown toenail surgery are provided with personalized care by our expert and experienced plastic surgeon Dr. Priyank Katwala. And this care starts right from the first visit of the patient. Patients are explained in detail about the phenomenon of an ingrown toenail and the measures required for its permanent cure. All steps of surgery are carried out by Dr. Priyank Katwala himself at Kosmetica, and he examines all operated patients of an ingrown toenail during their follow-up visits.

Aftercare tips

After ingrown toenail surgery, patients are advised to rest at home keeping the operated limb elevated over a pillow. The bed rest and limb elevation are maintained for 2 days, and the patient is asked to avoid going to school or office for these 2 days. From the third day onwards, the patient can move around and can start attending his work. The first dressing after the surgery is done on the 3rd day after the surgery, and then after 3 days of the first dressing, sutures are removed. The patient needs to do a few protective dressings by himself for a week after the suture removal, which is explained in detail and demonstrated to the patient and his family members. The patient is allowed to wear shoes between 7 to 14 days after the surgery. Strenuous activities like sports and running can be resumed usually after 3 weeks.

Prevention

Avoiding any trauma to the toenails helps a lot to prevent this problem from developing. Improper or very deep trimming of corners of nails is also to be avoided. Very tight shoes should be avoided. Taking proper care of feet is also helpful in avoiding developing ingrown toenails, especially in diabetic patients. However, despite all preventive measures, an ingrown toenail is not always preventable. Whenever symptoms develop, like pain, redness, and swelling at one or both corners of the toenail, the patient should immediately consult a plastic surgeon to seek early and permanent relief.