Ingrown Toenail Surgery

Ingrown toenail is the condition that most commonly happens to the great toe of feet either on one or both sides. It occurs as a result of the abnormal downward/inward direction of growth of the nail of the toe. Due to the downward or internally inclined growth of the nail, it strikes against the skin in an attempt to come out of the skin. In this situation, it becomes challenging for the patient to trim the nail in the normal way. Additionally, the slightest pressure from the outer aspect as may be by footwear or minor trauma, cuts the skin from within by pressing it against the advancing buried edge of the nail which leads to infection and pain. Such repeated episodes of infection and pain worsen the situation and if not treated, can frustrate the patient. The conventional method of treatment involves the removal of the edge of the nail causing the problem, which leads to temporary relief of symptoms only to reappear later. Permanent relief of this problem is ensured by permanently preventing nail growth at the offending corners. The plastic surgery technique of nail bed removal ensures permanent relief of this problem by removing of nail bed responsible for nail growth at the corners. A permanent cure for this problem is achieved by precise anatomical knowledge, the use of magnification, and the fine surgical skill of a plastic surgeon.

What is an Ingrown Toenail?

To simplify, in grown toe nail is the problem related to 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. In grown toe nail most commonly affects the nail of the great toe either on one or both sides of the one or both toes.

Causes

Causes of in grown toe nail are not known in all the patients. However, the most common causes are external trauma over the toe nails as happens in sports, abnormal nail pairing habits, diabetic foot infections, repeated minor injuries, very tight foot wear 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 toe nails.
• Comfortable foot wear.
• Consult a plastic surgeon in case of excessive pain, swelling or redness around the corners of nails.

Don’ts:

• Tight foot wear.
• Abnormal nail pairing habit.
• Repeated trauma over the toe tips.
• Conventional treatment by complete removal of toe nail.

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 in to 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 tip or corner of the nail to its deepest extension below the skin at the base of the nail. Thus, removal of 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 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 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

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

Why Cutis Hospital for Ingrown Toenail Surgery?

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

Aftercare tips

After ingrown toe nail 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 patient is asked to avoid going school or office for these 2 days. From third day onwards, patient can move around and can start attending his work. First dressing after the surgery is done on 3^rd day after the surgery and then after 3 days of first dressing, sutures are removed. Patient needs to do few protective dressings by himself for a week after the suture removal, which is explained in details and demonstrated to the patient and his family members. 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.