Ingrown Toenails

Ingrown toenails affect everyone of all ages and are quite frequent. Though it is not a life-threatening ailment, it can cause immense pain and irritation. An ingrown toenail occurs when the corner or side of your toenail grows into the soft flesh next to it. This can happen due to several reasons such as wearing shoes that are too tight, not trimming your nails properly, an injury to your toe, or even genetics. The most common symptom of an ingrown toenail is pain and tenderness along the side or edges of your toe.

Treating ingrown toenails with antibiotics alone

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

How to surgically treat an ingrown toenail

Definitive treatment involves resection of the ingrown margin of the toenail. The first step in this procedure is administering a digital block, which is an anesthetic to the toe. Through my years in practice, I have become quite skilled in administering these injections as comfortably as I can. The 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. 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 fluid from drying at the site of surgery which could potentially lead to infection.

Typically, it takes 3-4 weeks for a 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, or 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 the setting of prosthetic heart valves. This is not necessary.

An alternative to ingrown toenail surgery

At District Foot and Ankle, we also offer an alternative procedure for incurvated/curvy toenails. The name of the procedure is called Onyfix.

Onyfix is a composite material that is secured to the base of the toenail. The purpose of this material is to allow the toenail to become flatter as it grows out. As such, the outer margins of the toenail will not be digging into the skin as much and leading to pain relief and reducing the likelihood of infection as well.

Onyfix is not an option for infected ingrown toenails. If the infection can be controlled with antibiotics and local care, then Onyfix can be considered down the road once the infection is completely resolved.

If the infection cannot be relieved with antibiotics and local care, then a procedure as described above needs to be performed in Onyfix unfortunately would not be an option.

Onyfix has a high success rate and patients are typically quite happy with the results.