An ingrown toenail can be very problematic with pain limiting your activities of daily living with further complications of recurrent infections requiring repeated antibiotic courses.
Our treatment of an ingrown toenail is minimally invasive. We do so by removing the ingrown portion of the nail and using phenol to stop that in-turned portion growing back again. In comparison to the traditional Hospital based open surgery which will have you off your feet for a few weeks while the wounds heals via sutures (that also need to be removed at a later stage).
The wedge excision and phenolisation method we use will have you back on your feet after the procedure with minimal after care as outline below. Active sporting people are usually back to sport with 1 to 3 days.
- Causes of an ingrown toenail
The most common cause is wearing shoes that crowd your toenails, over time the margin of the toenail turns in on itself. Other causes include; toenails cut too short or not straight across, Injury to the toenail or just having unusual curvature in the toenails.
Early recognition will allow you modify your foot wear or how you have being cutting them. Lifting a corner of the nail by inserting a wisp of cotton wool over months may also be enough. Failing this you might need to have the ingrown section treated by an operation.
Wedge excision and nail matrix phenolisation
With the application of local anesthetic to the big toe (called a sensory ring block) the sensory nerves supplying the toe are numbed so from that point on you should not experience pain.
We are conscious of the fear that patients can have of needles and we therefore use the smallest diameter one (needle we also use in anti-wrinkle injections to the face) and most people do not experience much in the way of discomfort. We allow the local to take effect over 15-20 minutes and will last up to 3 hours.
As detailed above the section of the ingrown nail is removed and then a small cotton swab containing phenol is applied to the nail matrix. The phenol chemical destroys that section of the nail matrix not allowing the ingrown section to regrow. The resulting nail width will be smaller, cosmetically we keep this to a minimum and will be discussed with you at the preoperative consultation .
Your foot wound is then dressed with a small anti-bacterial wick with an overlay of a compression dressing which will allow your foot to go into a wide fitting shoe or an open sandal.
The procedure takes about 40 minutes.
After care postoperatively
We would ask you to elevate your foot above your heart level on a couch (supported by pillows) for the remained of the day. This in addition to the compression dressing fitted greatly reduces chance of swelling and a quick return to your normal activities.
The dressing we fit is worn for 2 days. After this you will need to bath your foot twice a day in a chlorhexidine (eg salvon) foot baths or if the skin is quite soft salt baths (eg. epsom salts) for the next 2 to 3 days and cover with a breathable non stick bandage (eg. mepore) if wearing a shoe.
Wearing open top shoes such as sandal promotes hardening of the skin. If you have any concerns please contact the clinic for a review appointment.
What do I need to do now
You may have been told by a healthcare profession that you need to have the ingrown toenail removed as it has failed conservative measures and they can refer you onto our service or you can self refer.
We welcome you for a preoperative consult if you are unsure as to the need of the procedure or if you feel the toe might be infected. It is important that any infection is treated as this reduces the effectiveness of the local anesthetic and slow the healing process post-op.
Cost of Procedure
- €100 facility fee in addition to health insurance (all major health insurers)
- €250 without health insurance
- €30 Preoperative consult (inclusive of prescription if required)
Following the procedure most people are back on their feet that day pain free! If the toe was swollen preoperatively you may be advised to elevated it for the remainder of the day to aid healing.
On the day you will receive written instruction on aftercare.
For more information you can visit Ingrown toenail on HSE website.