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INGROWING TOENAIL
What is an ingrowing toenail?
An ingrown toenail develops when the sides of the toenail grow into the surrounding skin. The big toe is often affected, either on one or both sides. The nail curls and pierces the skin, which becomes red, swollen and tender.
Symptoms include:
• Pain if pressure is placed on the toe.
• Inflammation of the skin at the end of the toe.
• A build-up of fluid (oedema) in the area
surrounding the toe.
• An overgrowth of skin around the affected toe
(hypertrophy).
• Bleeding.
• White or yellow pus coming from the affected area.
What causes ingrown toenails?
A number of things can cause an ingrown toenail to develop, including:
• Badly cut toenails – cutting your toenails too short, or cutting the edges, will encourage the skin to fold over your nail and the nail to grow into the skin.
• Wearing tight-fitting shoes, socks or tights – this places pressure on the skin around your toenail; the skin may be pierced if it's pressed on to your toenail.
• Sweaty feet – if the skin around your toenails is soft, it's easier for your nail to pierce it and embed itself within it.
• Injury – for example, stubbing your toe can sometimes cause an ingrown toenail to develop.
• Natural shape of the nail – the sides of curved or fan-shaped toenails are more likely to press into the skin surrounding the nail.
• A fungal nail infection can cause your toenail to thicken or widen.
What does surgery include?
Partial nail avulsion:
This would be to remove part of your toenail. It is a common operation for treating ingrown toenails.It's about 98% effective. Usually, a local anaesthetic is used to numb your toe and the edges of your toenail are cut away.
A chemical called phenol is applied to the affected area to prevent the nail growing back and becoming ingrown in the future. We might request you to go to your GP for a prescription for antibiotics prescribed if your nail is infected.
Total nail avulsion
Total nail avulsion completely removes your toenail. This may be necessary if your nail is thick and pressing into the skin surrounding your toe.
After you toenail has been removed, you’ll have an indentation where your nail used to be. However, it's perfectly safe for you not to have a toenail.
After surgery
After Toenail surgery, your toe will be wrapped in a sterile bandage (inner layer). This will help stem any bleeding and prevent infection. To help reduce the pain, you may need to take a painkiller, such as paracetamol.
Possible complications can sometimes be:
1. Infection around the surgical site.
2. Infection in the underlying bone.
3. Recurrence of the ingrown toenail.
Most complications in toenails surgeries are resulting from the post op swelling and bleeding.
This can be avoided by elevation of the foot for 2 weeks.
Do not play sports or do strenuous exercise for 2 weeks.
Keep the dressing dry and clean during the early days post op (do not change dressing unless it is necessary).
It is very important to NOT changing the inner dressing too early as it may peel off the healing layer of skin which would be stuck on to the dressing. This would delay the healing and the recovery and potentially cause infection.
Spend most of the time during the first few days with your leg raised so that the swelling settles. After that, you can usually start to be a little more active.
When can I return to work?
Your own circumstances will determine when you feel ready to go back to work. If you have an office-type job and you can elevate your leg then you should be able to return to work within 7 days. If your job requires a lot of walking or is strenuous then you may need 2-3 weeks off work. Patients can selfcertificate their sick leave for 7 days. If you require a sick certificate please ask your GP.
When can I return to driving?
You will be able to return to normal sporting activity usually between 8-12 weeks after your operation, contact your GP for further advice.
When can I return to driving?
You must be free of pain and able to perform an emergency stop. This will also depend on which foot was operated on (right or left). The NHS website advise you should not drive until you feel it is safe to do so, usually this could be up to 2 weeks after the procedure. If you are unsure, contact your GP for further advice and also check with your insurance company.