What are ingrown toenails?
Ingrown toenails (Onychocryptosis) are toenails that have pierced the skin or are pressing against the adjacent skin of the toe causing pain, inflammation and sometimes infection. Initial symptoms include minor discomfort and inflammation, usually after the nail pierces the skin of the toe.
A relatively common condition, ingrown toenails can result from poorly fitted shoes, trauma, hereditary and inherited conditions, nail picking and incorrect nail trimming. Once the nail has pierced the skin, infection can occur quickly, both under the nail and in surrounding areas. This will be evidenced by swelling, redness and discharge. In addition, pain will increase, often making it difficult to walk or wear enclosed shoes.
Ingrown toenails can sometimes resolve without treatment. Soaking the toe in warm salt water solution and elevating the foot to reduce swelling and pain, are sometimes all that is required. However, persistent pain and inflammation must be checked by a medical professional. We offer the most simple and effective treatment for your ingrown toenails offering both surgical and non-surgical options. If you think you have ingrown toenail/s or you have tried other treatments unsuccessfully then please contact us HERE to make your appointment today.
What causes ingrown toenails?
Poor nail cutting technique can result in the nail being cut too far down on one side, creating a small spike of nail which pierces the skin and results in the ingrown toenail.
A trauma to the toe caused by an injury, causing disfigurement to the toe or nail.
Incorrectly fitted shoes, not allowing enough space for the nail to grow.
Repeated pressure during activities like walking and running so as above make sure running shoes are right size and suitable for your sport.
Structure of the nail. If your nail is wide or overly curved it can push down onto and pierce the surrounding skin. Once the toenail has pushed through the skin, the body identifies it as a foreign object leading to redness, swelling and pain while the broken skin increases the risk of infection. This typically type of nail that grows-in regularly, surgical intervention is the best option.
How can you prevent ingrown toenails?
Being aware of some of the risk factors associated with the development of ingrown toenails can help early detection, as well as allow prevention of symptoms worsening in the early stages.
Some people need to be especially careful to maintain good foot hygiene. Such as those with diabetes, congenitally deformed toenails or an abnormal gait and those who are obese. In addition, sufferers of arthritis, oedema and hyperhidrosis should regularly visit a podiatrist for correct nail cutting and foot maintenance.
Trim your toenails properly and regularly to keep them healthy and strong. Trim them straight across, rather than trimming edges into a curve. Avoid trimming them too short (unless you have been advised to do so by your podiatrist).
Wearing shoes that fit properly. One of the primary factors that predispose a person to develop an ingrown toenail is unfitted shoes. Whether too small or too large, improperly fitted footwear puts enormous stress on the toes, including the nails and surrounding skin. We can advise you on the correct shoes for your foot type.
Is it painful?
Advances in techniques over the years have allowed podiatrists to use local anaesthesia to produce a highly effective ‘block’ of your toe, so that there is absolutely no discomfort or pain during or immediately after the procedure. There are typically two injections given in the base of the toe. After that, there will be no pain at all whilst the procedure is undertaken.
Please contact us if you are worried or concerned about having injections and we can help put your mind at ease.
The amount of time off required varies depending on your occupation and work duties. Many people will be able to return to office based activities within 1-2 days, but more high demand occupations (eg tradesman, nurses, teachers) may require a few extra days of rest and elevation. Your podiatrist will provide you with detailed advice on returning to work, and can supply you with a Medical Certificate after the procedure. School aged children are advised to have 3-4 days off school so that the toe does not get traumatised in the playground.
As there is no cutting through the skin, or stitches, the procedure preferred at the Canberra Ingrown Toenail Clinic rarely causes a lot of post operative pain. It is almost like a form of ‘keyhole’ surgery. Most patients will manage their discomfort with simple over the counter pain medication, and elevation and rest. This usually lasts for the first 24 -48 hours at the most, and in our experience it is rare for patients to complain of any significant pain.
Do I need an initial consultation?
All surgical procedures require careful assessment before we can advise if this is the right option for your problem. Our podiatrists need to review your overall health, medications, circulation and the nature and extent of your problem before we can give you the correct advice about treatment. Sometimes surgery is not necessary, and simple conservative care may address your problem. If there has been long standing infection, we may need to organise an x-ray of your toe to ensure there is no bone infection present. If you have diabetes or other significant health issues, we may need to liaise with your regular GP to ensure you are cared for properly. We also recommend you seek a second opinion before making any decision about having surgery.
Can I have toenail surgery if I have Diabetes?
In most cases, yes. However, some patients with diabetes may be at higher risk for post-operative infection and delayed wound healing. There is a slightly increased risk of post operative infection in diabetes, particularly if your blood glucose control is not optimal. It is advisable to have your BSLs under control before any surgical procedure. If you have diabetes, your podiatrist will carefully assess your circulation with a Doppler ultrasound and other techniques to ensure it is adequate to heal your toe. If the blood supply to your foot is not satisfactory, then it may not be possible to offer a surgical solution to your problem. In this situation we may suggest periodic podiatry treatment to reduce the symptoms associated with the ingrown toenail. This is similarly the case for other chronic health problems that can also affect your healing and circulation. Smoking is widely known to reduce circulation, therefore your GP may advise you to significantly cut back or quit before the procedure to support better healing.
Can I walk after the surgery?
Yes, you can walk straight away. Your toe will be numb for up to a couple of hours after you have the procedure. Please bring along an open-toed shoe to wear home or in Canberra’s cold winter, cut out the front of an old pair of joggers and bring socks. We recommend you get a responsible adult to drive you home, and then try and elevate the foot as much as possible for the next 24 to 48 hours. The dressing is sterile and MUST be kept DRY in the shower. We recommend a ‘bird bath’ for the first day or so.
How long does the procedure take?
Allow an hour for 1 toe and 1.5hrs for 2 toes. The actual procedure is only about 15-20mins but the paperwork and sterile set-up takes time.
When can I get back to playing sport?
In 2-4 weeks depending on the sport and the shoes worn. You can discuss the estimated time off with your podiatrist.
If I am pregnant or breastfeeding can I still have toenail surgery?
It’s generally not advisable as you will be administered local anaesthetic which gets into your blood stream. We can provide more conservative management of the nail condition until such time that we can safely perform the nail surgery.
How will my toenail look after surgery?
The appearance of the nail after surgery will depend greatly on the severity of the problem, the duration of the problem, the thickness of the nail, the condition of the nail (i.e fungal, traumatised), infections and previous treatments. Your Podiatrist can best advise from their clinical judgement, how the nail will look after surgery. It will not look the same and often will have a piece of nail edge obviously missing from the side/s. Sometimes the whole nail needs to be removed. If you are strongly concerned about the nails appearance post surgery, we suggest you have a specific conversation with your Podiatrist about the nails aesthetics as we can not guarantee that it will look ‘back-to-normal’ post surgery.
Does Medicare cover nail surgery costs?
If you qualify for an Enhanced Primary Care (EPC) program arranged by your GP, a portion of the associated costs may be covered by Medicare. Speak to your GP to see if you are eligible.
Does my private health fund cover nail surgery costs?
Most health funds provide rebates for nail surgery – check with your fund if you’re covered. We have HICAPS facilities so are able to offer on-the-spot rebates. If you would like the item code breakdown, please contact the clinic on 62932024.
What are the potential complications?
As with any surgical procedure, there is some risk of complication, however, this procedure is associated with a low rate of complication and is known to be very safe and effective. The most common side-effects are post-operative infection in the short term and the possibility of regrowth of the nail over time. The rate of regrowth is reported in the literature in less than 10% of procedures*
Healing time often depends on your immunity. If you are otherwise fit and healthy, the wound will usually heal up over 2-3 weeks, and require a simple light dressing to keep it clean. There are no stitches that require removal. We will usually re-dress the toe at about day 3 and day 7 after the procedure to ensure there are no problems. Then, you will be given a dressing pack and instructions on re-dressing at home. We then like to review the toe approximately 3-4 weeks post-op to ensure it is healing well. If you have diabetes or other health problems, this may slow down the rate of healing. If the toe gets wet in the first week post-op and the dressing is not changed immediately, your risk of infection increases. If you have multiple nails removed, this also tends to slow down the rate of healing.