Performed by – David Hinsley, Ngwe Phyo, Nick Ward

Ingrowing toenails most frequently affect the big toenail and are caused when the sides of the nail grow into the surrounding skin. The skin subsequently becomes red, inflamed and tender. Bleeding and secondary infection can occur, with pus coming from the area.

There are a number of causes including:

• Curved or fan-shaped nails that predispose to cutting into the skin.
• Cutting the nails too short or curving them at the leading edge corners.
• Excessive pressure on the skin at the corners due to tight ill-fitting shoes.

The aim of toenail operations is to remove the side portion of the nail that is “ingrowing”, or to completely remove the nail, so that that portion or the whole nail does not re-grow.

Under local or general anaesthetic, the side portion of nail, or whole nail, is gently lifted off the nail bed and small oblique incisions are made in the proximal nail folds. The germinal matrix (where the nail grows from) has a chemical (phenol) applied to it that prevents the nail re-growing in that area. Sutures are inserted to close the wounds and the toe is dressed in a bulky dressing.

Post operative rehabilitation
The foot should be elevated for 24-48 hours. Weight bearing is permitted, as comfort allows. The dressings should be changed at 48 hours and replaced with a smaller, lighter dressing. The sutures should be removed at 10-14 days.

If the wounds continue to ooze, then they should be bathed daily in warm salty water. Antibiotics are only required if the toe becomes red and inflamed, or if pus is present.