Ingrown Toenails

Ingrown toenails are very common and affect people of all ages.

Ingrown toenails can become infected. Infection is characterized by swelling, redness, pain and drainage.

One common problem I see in the management of ingrown toenails is isolated treatment with oral antibiotics. Antibiotics are useful for treatment of an underlying soft tissue infection; however, they will not treat the underlying cause of the infection. Unless the ingrown portion of toenail is removed, the infection will recur repeatedly, which may mean multiple courses of antibiotics, trips to the doctor, missed days from school/work, and spending unnecessary money.

Definitive treatment involves resection of the ingrown margin of toenail. The first step in this procedure is administering a digital block, which is anesthetic to the toe. Through my years in practice, I have become quite skilled in administering these injections as comfortably as I can. Bottom line, it is an injection, and it is impossible to perform this completely pain free.

Once the toe is numb, surgical instrumentation is used to free up the ingrown portion of the nail, which is then cut out. In order to reduce the likelihood of recurrence, a chemical called phenol is applied to the cuticle. This prevents the outer margin of toenail from growing ever again. It is very rare to see recurrence with this procedure. The toenail will be slightly narrower as a result of this procedure.

Post-operative recovery is quite straightforward. A dressing is applied to the toe immediately after the procedure and should be left in place for 24 hours. The dressing can then be removed and twice daily soaks with warm water and epsom salts should be performed. This is important for preventing serous fluid from desiccating at the site of surgery which could potentially lead to infection.

Typically, it takes 3-4 weeks for full recovery but there are no formal restrictions imposed. If you are a heavy athlete, I would ask that you either cross-train (avoid running, trail running, water sports) for a few days after the procedure to prevent infection.

Sometimes antibiotics are prescribed either before or after the procedure. This is determined on a case-by-case basis. I do not routinely prescribe antibiotics for this procedure.

Another common question is whether prophylactic antibiotics are required in the setting of a joint replacement (such as knee or hip) or in the setting of prosthetic heart valves. This is not necessary.

If you think you are suffering from an ingrown toenail, call Dr. Nodelman at District Foot and Ankle for a consultation today.