Nail complex surgery

Ingrown toenail

Ingrown toenail is a condition in which the nail grows so that it cuts into one or both lateral nail folds. Growth of the nail plate causes pain and inflammation of the nail fold. The nail may be growing into one or both sides of the nail at the same time. The problem concerns people of all ages, regardless of gender, however, majority of cases are found in young people.

Causes:
- wearing tight-fitting shoes which crowd toenails,
- improper cutting of the nails - including cutting nails too short and round instead of cutting them straight across,
- specific predisposition for this nail disease;

Symptoms:
- pain along the margin of the ingrowing nail - worsening of pain while walking and when wearing tight footwear,
- swelling and redness of the affected nail fold,
- the risk of bacterial infection of the affected skin (paronychia) - increased pulsing pain, swelling and redness of the skin around the nail, sensitivity to pressure of any kind, presence of pus,
- in more complicated cases, the infection may affect the whole finger, spreading just under the skin (so called phelgmon finger) - the finger appears red, swollen, hot and is very painful.

Prevention:
- avoid tight-fitting shoes,
- keep proper foot hygiene,
- cut your toenails properly - toenails should be cut straight across so they are square-shaped and not curved at the edges,
- avoid using sharp ends of scissors or of a nail file between the nail and the surrounding skin, as it may cause little injuries, leading to infection,
- in order to avoid the infection of nail folds, never cut cuticles with scissors or nail clippers; instead, the cuticles may be gently pushed back with a thumb after a few-minute soak in water;

Treatment:
1) conservative:
- in case of inflammation, warm water and soap soaks a few times a day may be helpful,
- in case of severe infection or inflammation - analgesics/anti-inflammatory medications,
- antibiotics - only in the cases of extensive and severe infection of the whole toe;
2) surgery:
- complete removal of the whole nail (the new nail usually has no tendency of ingrowing) - the procedure is nowadays rarely applied,
- partial avulsion of the lateral nail plate, known as a wedge resection - a part of the nail is removed with the affected nail fold. The resulting skin and nail defect may be stitched or left to heal without stitches. When the nail grows out, it recovers to its usual shape and has no tendency of growing into the toe again. Although it is initially slightly narrower than the corresponding toenail on the other foot, it comes back to its original width after a few weeks.