What is an ingrown toenail ?
Ingrown toenail occurs when the side edge of the nail pushes into the skin. It is a common condition that manifests itself in a painful conflict between the nail of the big toe and the skin : it becomes inflamed, red and swollen. It mainly affects the big toe but can also occur on the little toes.
Where does it come from and what are the aggravating factors?
The causes of an ingrown toenail are often due to improper cutting of the nail. The tendency is to cut the nail too short and in a rounded shape for aesthetic reasons. This cut promotes the formation of nail angles and the formation of ingrown nails.
Other factors favor the formation of ingrown toenail :
- Rounded toenail shape or too thick
- Excess sweating
- Tight, narrow or high heels shoes
- A history of nail trauma
- Pathologies of the toes such as axis problems which lead to a conflict between the toes (osteoarthritis, toe claws, hallux valgus, etc.)
- Certain diseases such as a yeast infection or onychomycosis
An ingrown toenail causes pain on the skin around the nail of the big toe It causes the formation of an inflamed piece of extra fleshy skin. The pain is accentuated when walking and with shoes on.
In the absence of treatment, this piece of skin evolves: it pusses and swells. The pain intensifies and becomes permanent and pulsating : it is the infected ingrown nail. This large pussing piece of flesh is also called botryomycoma.
At this stage, it is necessary to quickly consult a podiatrist or surgeon. To learn more about orthopedic ingrown toenail surgery , please refer to the " Ingrown toenail surgery " section.
What are the possible evolutions?
In the uninfected beginning stage (simple redness and pain), ingrown toenail can be cured with simple measures.
In the absence of appropriate treatment, the progression is worsening and becoming infected. In this case, it is advisable to consult a surgeon for ingrown toenails on the foot or a podiatrist.
How to treat an ingrown toenail?
- The first step is to stop cutting your nails for 1 month. During this phase, you risk an exacerbation of symptoms because the conflict between the nail and the skin will increase before it heals completely. During the worsening phase, the following measures should be taken …
- Perform antiseptic foot baths several times a day. You can use Dakin (or others like Chlorexidine) diluted 50% with hot water.
- Avoid tight shoes or high heels and prefer wearing wide shoes
- Keep the big toe as airy as possible and avoid airtight dressings
- Try to put a small bandage or cotton wool under the ingrown nail
This treatment is effective in a few days to calm the inflammation and it will take 1 month for healing : this is the necessary time period for the conflict to disappear with the regrowth of the nail. If, despite this treatment, the inflammation persists or the ingrown nail progresses to infection, it is necessary to consult an ingrown nail specialist. The infection is treated with antibiotic creams applied locally and by pedicurists. In the absence of healing, it will be necessary to consult a doctor specializing in ingrown toenails on the foot.
We also advise you to consult urgently in the presence of signs of lymphangitis (red line along the veins of the calf) or fever, chills or severe signs of infection.In other cases, a consultation with a foot surgeon is necessary to consider surgery for infected ingrown toenails on the foot . Some practitioners offer a laser on the ingrown toenail on the foot (If you want to avoid classic surgery, you can consult a dermatologist, some use a laser for the ingrown toenail).
In the case of a laser operation of the ingrown toenails on the foot , the operative consequences are simple. There are other treatment methods such as the use of a semi-insulated electrode on the dorsal side or even a chemical method using phenol, for example.
How to prevent an ingrown toenail?
The secret to preventing the appearance of an ingrown toenail lies in hygiene and in the cutting of the nail which must be strict. The nail cut must be done regularly, avoiding a circular or too short cut. In other words, the cut must be " square " so as to always visualize the 2 angles of your nail.
Shoes that compress the big toe or high-heeled shoes should also be avoided.
What does an ingrown toenail operation involve ? Everything you need to know about the ingrown toenail, its operation and prices.
If you have an infected ingrown toenail and medical treatment has failed, foot surgery may be offered. The main objective of the surgery is to treat the infection, to cure it definitively and to have a painless and shoe-able foot.
An operation on a toe for an ingrown toenail is necessary it becomes red and its pussing. An ingrown toenail specialist should be consulted to cure the infection after a short surgical procedure . To know the exact nature of the treatment to be performed for the ingrown nail, the surgeon will have previously specified certain elements in consultation. The choice of technique and the assessment of the actions to be performed is left to the surgeon depending on the severity of the damage and the complexity of the intervention.
Hospitalization:The operation usually takes place on an outpatient basis (hospital stay for one day) . However, for various reasons, it is possible to plan a few days of hospitalization depending on your social situation and your associated illnesses.
Anesthesia :You will have to carry out the obligatory pre-anesthetic consultation with the anesthesiologist. During this consultation, the anesthesiologist will explain the possible options of anesthesia to you according to your associated pathologies and the planned operative procedure. If necessary, he will adapt your treatment before and after the operation and may prescribe anticoagulants, painkillers, anti-inflammatory drugs or others.
Several types of anesthesia are possible : you may benefit from local or regional anesthesia meaning that only your leg will be desensitized : this is the most common. General anesthesia is also a solution if you prefer to go asleep.
The intervention:- Before the operation of an ingrown nail : you will be placed on a stretcher and then taken to the pre-anesthesia room. Local anesthesia will be performed before entering the operating room.
- Installation in the operating room : You will be placed in the supine position, that is to say on your back.
- The tourniquet : Throughout the operation, a tourniquet is usually placed at the base of the big toe to prevent bleeding.
- The incision : The incision measures a few millimeters with the minimally invasive technique. It is performed at the base of the nail and in the axis of the toe. One or two incisions are made depending on whether the surgery is performed on the inner edge, the outer edge or both edges of the toe.
- The surgical procedure : the orthopedic surgeon removes a quarter of the nail and the infected flesh with a cold blade. He will also remove the corresponding nail matrix in order to sterilize it and have a lasting result without recurrence. The incision is stitched with an absorbable thread stitch. It is possible to have an ingrown toenail operation without stitches on the foot if you wish (you must ask the surgeon during the consultation).
- Operative time : the duration of the surgical procedure is relatively short, generally 20 minutes. The intervention may be longer in the event of associated procedures or operating difficulties.
- The material : No material is necessary.
- At the end of the operation : The surgeon makes a large bandage.
It is important to note that the surgeon may face unforeseen or unusual situations requiring different acts than those initially planned. In this case, the surgeon will explain the difficulties encountered and the actions taken as soon as you wake up or return to your room.
In conclusion :
Ingrown toenail surgery on the foot is a frequent and low-risk procedure. It is often performed during an outpatient hospitalization and does not require any immobility.
What happens after the operation?
WALKING
As soon as you leave the operating room, walking is authorized. In some cases, a therapeutic shoe is prescribed to facilitate walking and pain. Otherwise, you can put on regular shoes if the pain permits. You must strive to walk with your whole foot and not just with the inner edge. Crutches can be useful for the first few days to make walking easier.
THE BANDAGE
At the end of the operation, the surgeon makes a large bandage. This dressing will be redone and lightened by the nurse as soon as you return home.
SWELLING
Swelling is not a complication and is a common occurrence after an operation. To speed up its healing, it is recommended to regularly ice the foot and put the foot up as soon as you feel the swelling. It takes about 1 month for the swelling to resolve 80% and 2 months for the foot to deflate completely.
HOME CARE
A nurse will come every 2 days to change the dressing for 21 days. Remember to contact a nurse before the operation.
MEDICINAL TREATMENTS
Depending on your history, your existing medical conditions and your mobility, the anesthesiologist may prescribe anticoagulant treatment by injection (subcutaneously) or systemically (per os). This treatment helps prevent the onset of phlebitis, i.e. the formation of a clot in the veins. It is strongly recommended to take the painkillers prescribed systematically during the 2 days following the surgery.
PHYSIOTHERAPY
Physiotherapy is not always necessary, its usefulness will be evaluated by the surgeon during your first postoperative consultation. In order to accelerate the functional recovery and the melting of the swelling, self-rehabilitation is essential. If necessary, physiotherapy sessions will be prescribed to you during your first postoperative appointment.
DRIVING AND STOPPING WORK
Driving is authorized by the surgeon (remember to contact your insurance to find out if you are covered in the event of an accident).
The average time off work is 1 to 4 weeks depending on your professional activity.
SPORTS ACTIVITIES
You can resume sports from the 3rd week.
POST-OPERATIVE FOLLOW-UP
An appointment is expected postoperatively up to the 21st day.
IN CASE OF QUESTIONS
For any additional questions or in the event of a problem, you can contact him or call his secretary.
In conclusion
The operation of an ingrown nail is a frequent and rapid operation. Surgery should be considered if simple local medical care has failed. The intervention is performed on an outpatient basis and walking is authorized immediately.
COMPLICATIONS
The following list of complications is not exhaustive, but the most frequent complications are mentioned.
For the ingrown nail , surgery exposes you to complications that are both common and specific to the type of intervention performed. This risk varies from one individual to another depending on their age, existing medical illnesses (hypertension, diabetes, poor skin condition, etc.) as well as depending on their lifestyle (tobacco, alcohol)
Some complications can be prevented by simple measures such as:
- Compliance with postoperative instructions
- Quitting smoking
Common Complications
- Hematoma is an infrequent complication, favored by certain drug treatments (anticoagulants). Some high-risk drugs can be stopped and relayed by the anesthesiologist. The hematoma rarely requires surgical revision, it usually resolves with ice and rest.
- The healing problems are rare thanks to the use of a minimally invasive technique. Their occurrence is increased by tobacco and poor skin conditions.
- Swelling is not a complication but a reaction of the body to the aggression that surgery represents. In order to decrease its importance, it is useful to carry out self-rehabilitation by moving the toes, to elevate the foot as much as possible and to ice regularly.
- The thrombophlebitis is the formation of a clot in a vein, usually in the leg or foot. Its prevention is walking and possibly, according to the anesthetic prescriptions.
- Algodystrophy or " complex regional pain syndrome " is an overreaction of the body to the aggression of surgery. The symptoms are: redness, stiffness, swelling and pain. The evolution is always towards healing without sequelae but the evolution is long (up to 18 months). Certain simple measures minimize this risk : the pain must not be allowed to set in and the painkillers prescribed should be taken systematically during the postoperative 48 hours.
- Infection can occur despite precautions (preoperative shower, surgical aseptic preparation). It should be evoked in the event of fever, scar breakdown, discharge or significant redness. It requires surgical advice.
Specific complications
The most common (but rare) specific complication is the partial recurrence that is to say of a small piece of nail regrowth. It requires surgical revision if it becomes annoying.
FAQ
What is an ingrown nail?
Ingrown toenail occurs when the side edge of the nail pushes into the skin. It is a common condition that manifests itself in a painful conflict between the nail of the big toe and the skin : it becomes inflammatory, red and swollen. It mainly affects the big toe but can also occur on the little toes.
Ingrown toenail who to consult?
In the presence of an ingrown toenail, you can consult the podiatrist, your doctor or a specialist surgeon. Regardless of the specialist, medical and non-surgical treatment is always indicated as a first-line treatment. It is important to call your doctor in the days following the discovery of the ingrown nail especially if you are diabetic, if you suffer from cardiovascular disease of the lower limbs, a disease of the heart valves, or a neurological or immune disease.
In case of failure, you can consult Dr. Lopez, an ingrown nail surgeon, to consider an ingrown nail operation in Nice or an ingrown nail operation in Nice. (Since 2021, Doctor Lopez no longer practices ingrown nail operations in Monaco, he now operates exclusively at Saint George’s Clinic in Nice) For patients who live on the island of beauty, it is sometimes difficult to make an appointment with an orthopedic surgeon for ingrown toenails in Corsica. If you cannot get an appointment, Dr Lopez can see you in Nice.
How to treat the ingrown toenail and avoid the operation?
It is not necessary to see a doctor or specialist if you have an ingrown toenail that is starting. If you don't have an infection, here are some tips for treating your ingrown toenail on your own:
- The first step is to stop cutting your nails for 1 month. During this phase, you risk an exacerbation of symptoms because the conflict between the nail and the skin will increase before it heals completely. During the worsening phase, the following measures should be taken ...
- Perform antiseptic foot baths several times a day. You can use Dakin (or others like Chlorexidine) diluted 50% with hot water.
- Avoid tight shoes or high heels and prefer wearing wide shoes
- Keep the big toe as airy as possible and avoid airtight dressings
- Try to put a piece of compress under the ingrown nail
Ingrown toenail operation?
The orthopedic surgeon removes a section of the nail and the infected flesh with a cold blade. He will also remove the corresponding nail matrix in order to sterilize it and have a lasting result without recurrence. The incision is stitched with an absorbable thread stitch. However, it is possible to have ingrown toenail surgery without stitches on the foot if desired.
How long does the operation of an ingrown nail take?
The duration of the surgical procedure is relatively short, generally 30 minutes. The intervention may be longer in the event of associated procedures or operating difficulties.
What is the anesthesia during the operation of an ingrown toenail?
You will have to carry out the obligatory pre-anesthetic consultation with the anesthesiologist. During this consultation, the anesthesiologist will explain the possible options of anesthesia to you according to your associated pathologies and the planned operative procedure. If necessary, he will adapt your treatment before and after the operation and may prescribe anticoagulants, painkillers, anti-inflammatory drugs or others.
Several types of anesthesia are possible : you may benefit from local or regional anesthesia meaning that only your toe or your leg will be desensitized : this is the most common. General anesthesia is also a solution if you prefer to go asleep.
How much pain do you feel after an ingrown toenail operation?
Ingrown toenail surgery is not very painful. Immediately after the operation, the pain is not felt because the foot remains asleep for several hours. Then the painkillers prescribed by the anesthetist provide adequate relief. To reduce the pain, it is essential to take painkillers systematically on the day of the operation and the next day. You should also freeze the foot regularly after surgery.
What is the period of immobility after an operation for an ingrown toenail?
No immobility is necessary : you have the right to walk immediately after the procedure and to put on normal shoes. The sick leave varies a lot with your professional activity and the intervention carried out : it is 1 to 4 weeks on average.
Am I allowed to drive after ingrown toenail surgery?
No surgical contraindication stands in the way of driving. If you are allowed to walk, you can press a pedal safely. You have the right to drive a motor vehicle as soon as you feel able to do so. In the event of a serious accident with bodily injury, you could have a lack of insurance because you will not be considered in possession of all your physical capacities. Remember to check with your insurance that you are covered after such an operation.
Can we operate on both feet at the same time ?
No, it is not possible to operate both feet at the same time. However, you can operate on two ingrown toenails on the same toe during the same operation. On the other hand, it is possible to operate on both feet a few days or more apart.
What is the price of an ingrown toenail intervention operation?
The price of the operation of ingrown toenails on the foot depends on the number of ingrown toenails to be operated on and the actions to be performed . Social security covers the costs of the operation. The reimbursement of additional fees depends on your insurance contract. The average remaining charge after reimbursement by your insurance company is € 300.
Discover the other pathologies of the forefoot by clicking here.
