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An ingrown toenail is a medical condition where the outside edge(s) of the toenail becomes embedded into the soft tissue of the toe, causing irritation, pain, hypergranulation tissue or infection. Ingrown toenails are relatively common, and can affect people of any age, however they tend to have a higher incidence in active teenagers, and also the elderly. There are several well known causes for ingrown toenails, and sufferers may have one or more reasons why they have developed problems. This is often present from birth (congenital) and means that one or more nails have become involutedor convoluted. Any injury to the toe that damages the nail and the growth area of the nail (the matrix), can cause the nail to begin to grow in an unusual manner that can lead to the nail to be deformed, thickened or grow in an irregular direction.
When the nail is cut too aggressively into the corners or down the side, it is possible to either leave an irregular edge to the toenail, or even have a small piece of nail come away and become stuck into the side of the toe causing a foreign body reaction (or granuloma). The culmination of years of wearing enclosed footwear, and repeated small knocks and bumps to toes and toenails can cause the toenail to gradually become deformed and have irregular growth.
If you suffer from hammertoes, bunions, very high arched feet and many other conditions, the position of the toe (and toenail) can be altered from its most ideal alignment. Please noteThe information on this website is intended as a guide for patients who have ongoing problems with ingrown toenails, and emphasises the role of minor surgery to resolve this issue.
If you have ever suffered with problems associated with your toenails and had them incorrectly cared for, then you can certainly appreciate how excruciatingly painful and debilitating they can be. If an ingrown toenail is simply viewed as nothing more than an infection or nothing more than a foreign body reaction on their own, then even the most experienced surgeon can be defeated by this troublesome complaint.
For example, I have performed surgery on a number of patients who have received multiple courses of antibiotics by their family doctor in a failed attempt to try and treat this stubborn condition.
Conversely, I have also seen patients who have been assured by their chiropodist that the spickule causing the foreign body reaction has been removed, only to present to my office with pus still oozing from the toenail demonstrating clearly the infection has not been addressed. When the processes of infection and foreign body reaction together are fully addressed only then is curative surgical treatment for ingrown toenail successful. Chemical destruction of the nail bed using 80% strength phenol, is my surgical procedure of choice for problem ingrown toenails. A rubber bandage (tourniquet) is applied to the toe in such a manner as to squeeze the blood out of the toe and back into the body. The toe is carefully checked for total numbness and then attention is drawn to the affected nail border.
The open wound of the nail border is thoroughly dried and the section of removed nail plate is checked to insure that its root is intact. When healed the toenail is narrower and over the next several months the soft flesh reforms itself into a new nail border (Fig 15).
An ingrown toenail occurs when the edge of the nail grows down and into the skin of the toe.


An ingrown toenail (also known onychoroyptosis or uniguis incarnates) occurs when the an individual's toe nail grows within the bed of the surrounding skin.
Ingrown toenails can be treated by the individual, however, it is important to see your doctor if you are experiencing severe pain, pus, redness, or poor circulation problems, including those with diabetes. Once the nail has been damaged in this manner, it is unlikely to ever go back to its normal appearance. Leaving the nail slightly longer, cutting along the natural curve of the nail, and not cutting down the side of the toenail can prevent this occurring.
This may cause the toenail to be frequently in direct contact with the ground, or in an unusual position which puts pressure of the soft tissues and the nail bed. This information does not replace comprehensive assessment and advice given by a podiatrist or other health practitioner.
The following article will inform serious tri-athletes about the condition of infected ingrown toenail and its correct treatment and care.
The pain experienced ranks up there with labour pains in women, toothache and slipped disc.
People, who are into self-treatment for involuted and convoluted toenails, by digging down the border of the toenail, may often get away with it. As the toenail slowly grows out then this spickule cuts into the sensitive flesh of the nail border. Chemical destruction of the nail bed treats both the infection and the foreign body reaction by permanently removing the offending nail. With careful selection of candidate, all instrumentation is sterilised and the foot is prepared with a surgical scrub.
This renders the toe white and bloodless for a controlled and short as possible period of time. A specialised surgical instrument is introduced to gently free the soft tissues attached to the top of the nail plate. This chemical application is carried out at least twice during the procedure with additional massaging of the phenol soaked tissues using a miniature surgical file (Fig 14), giving particular attention to the germinating matrix tissue where the nail grows from.
An antiseptic compression dressing is applied and the patient instructed on after care with emphasis on foot elevation above the hip for the remainder of the day.
Results look so good that it is difficult to see where the surgery took place but by comparing one toe with its opposite number on the other foot the difference in width is the only telltale sign. As a podiatric surgeon I recommend early care at even the slightest sign of trouble is the best action to maintain good health of your toenails. Scullion is a podiatric surgeon and has been in private practice in The Castleknock Clinic, 23 Castleknock Avenue, Castleknock, Dublin for 23 years.
There may be pain, redness, and swelling around the nail. Causes An ingrown toenail can result from a number of things, but poorly fitting shoes and toenails that are not trimmed properly are the most common causes.


Additionally the Podiatry Board of Australia guidelines recommend that all patients considering any surgical procedure should always seek a second opinion regarding their problem.
Just ask anyone who has had this condition with someone having inadvertently stepped on it. In a recently published scientific paper the chemical destruction of the nail bed technique was deemed to have a success rate in the high 90% range. A cut is made at the free edge of the toenail to allow the insertion of a fine surgical chisel. The patient is also instructed on twice-daily saline footbaths and strong antiseptic redressing. He has also guest lectured over a 10 year period in lower limb biomechanics for the MSc in Sports Medicine at Trinity College, Dublin.
Another technique, surgical excision of the nail bed, was demonstrated to have a success rate only as high as 50%. The full operation takes less than 15 minutes and falls well within safe margins for circulation to be temporarily cut off from a healthy digit.
This instrument is then pushed along the nail plate, under the soft tissue fold and down through the germinating matrix. The great toe is usually affected, but any toenail can become ingrown. Ingrown toenails may occur when extra pressure is placed on your toe. At this stage two definite disease processes have begun; Infection and foreign body reaction. This incision frees the troublesome section of nail, which is removed using a fine clamping forceps (Fig 12).
Of particular note to athletes is the fact that most normal training activities can be continued with just 48 hrs following this surgery, however as much rest as possible will always insure faster healing. If you walk often or participate in athletics, a shoe that is even a little tight can cause this problem.
This will only make the problem worse. Consider wearing sandals until the problem has gone away. If you have diabetes, see your health care provider. Prevention Wear shoes that fit properly.



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