Approximately 7.1 million people in America suffer from ingrown toenails. This is a common condition where the nail curves at such an angle that it pierces and begins growing into the flesh surrounding it.
Ingrown toenails are very painful, often negatively impacting a person’s ability to walk comfortably. The skin becomes inflamed, red, and swollen. Other symptoms may include pain when pressure is applied to the affected toe, fluid buildup in the area, skin overgrowth, bleeding, and pus (white or yellow) oozing from the toe that may smell.
The majority of the time, an ingrown toenail can be treated at home. Your doctor may prescribe medication if the pain is particularly severe or the toe becomes infected. Though an ingrown toenail isn’t life threatening, complications can occur, particularly if you have a disease that affects the circulation in your legs and feet. While toenails are the most common place people with get ingrown nails, you can also develop an ingrown fingernail.
Causes of Ingrown Toenails
Ingrown toenails are caused by a number of things such as:
- Tight-fitting shoes or socks – The pressure from shoes or socks that are too tight can force the skin to press against the toenail, leading the nail to push into the skin.
- Poorly cut toenails – Cutting the nails too short or clipping off the sides will cause the skin to collapse over the nail and encourage the nail to pierce it.
- Injury – Stubbing your toe or otherwise sustaining an injury in the area can force the nail into the skin.
- Sweaty feet – Skin that is constantly moist tends to be soft. This, in turn, may make it easier for the toenail to cut into the skin.
- Nail shape – You are at an increased risk for ingrown toenails if your nails fan out or curve at the sides as it grows.
- Infection – Nail fungus infections cause nails to become thicker and/or get wider, leading to a greater chance of them curving into the flesh.
Treatment for Ingrown Toenails
There are several different things you can do to fix an ingrown toenail. The severity of your condition will dictate which one is best for you.
If you catch the ingrown toenail early enough, you can redirect its growth away from the skin. Although it may be best to have a doctor perform this procedure, especially if you’re experiencing pain in the area, you can do this at home to fix a mild ingrown nail. You’ll need a pair of tweezers, antibacterial soap, rubbing alcohol, gauze, and some cotton balls.
- Soak the toe in warm water for about 10 to 15 minutes and then gently wash it using antibacterial soap. Rinse thoroughly.
- Sterilize the tweezers by dipping in the rubbing alcohol.
- Pull the flesh away from the toenail and then gently lift the nail from the skin using the tweezers. Lift it as far as is comfortable. Work carefully to avoid aggravating the sensitive area.
- Holding the nail steady, use your other hand to push a small piece of a cotton ball underneath the nail. Again, be gentle and don’t jam it in or you may hurt the toe even worse. The cotton will force the toenail to grow over the skin as it should have in the first place.
- Loosely wrap the toe with a bandage to keep bacteria out and catch any pus or blood that may ooze from the area.
- To prevent infection, clean the toe with antibacterial soap or rubbing alcohol and replace the cotton at least once per day. If you have sweaty feet, you may need to do this more often.
- If the nail is long in the area that pieced the skin, use nail clippers or an emery board to shorten it so that it’s not poking into the skin. Take care to avoid shortening it too much, and make sure the nail is smooth to reduce the risk of it catching on the skin again as it grows.
- You may want to follow up with antiseptic cream once or twice per day to prevent bacteria from invading any open wounds you may have in the area.
- Take an over the counter pain reliever such as ibuprofen or acetaminophen to get relief from any discomfort you may be experiencing.
If the ingrown nail is particularly severe, it may need to be partially (partial nail avulsion) or completely (total nail avulsion) removed. Both of these treatments should be performed by a doctor, especially if the pierced skin is swollen or oozing pus.
With a partial nail avulsion, the doctor will inject a local anesthetic into the area to numb it. He or she will then remove the part of the nail that is causing the problem. Afterwards, the doctor may destroy the nail matrix at the sight of the ingrown nail to prevent it from growing back. This treatment is a good option if ingrown toenails are a chronic problem for you.
If the nail is particularly thick, you have a severe infection, or you’re constantly having a problem with ingrown toenails, the doctor may perform a total nail avulsion. Complete removal of the nail is not harmful, but it may be unsightly.
Ingrown Toenail Surgery
Regardless of whether part or your entire toenail is removed, the procedure is pretty much the same. If it’s been five years or more since your last tetanus shot, you will be given one to eliminate the risk of getting this infection in your toe after surgery. The doctor may also order x-rays of the toe to determine if any infection you do have has spread to the bone (osteomyelitis). If so, then you’ll need to take antibiotics for a long period of time to clear the infection. Severe bone infections may require the doctor to cut to the bone and manually clean it out, and an especially bad infection may result in complete loss of the toe.
If everything looks fine on the x-ray, the doctor will numb the entire toe. He or she will drain the toe if it is infected before removing any excess tissue that has formed around the ingrown nail and the part of the nail that has pushed into the flesh. This surgery is called wedge resection. If deemed necessary, the doctor may also apply a chemical medicine or use a manual surgical technique such as lateral matricectomy to destroy the tissue on the nail bed to prevent the nail from growing back.
Once the surgery is completed, the doctor will apply a medicated ointment and then wrap the toe in gauze.
While wedge resection and avulsion are two of the most common type of ingrown toenail surgeries, there are other types that may be conducted depending on how bad the ingrown toenail is and the outcome you and your doctor want.
- Vandenbos procedure – First performed in 1959, this procedure involves anesthetizing the toe and placing a tourniquet on it. The doctor then cuts directly into the toe starting about 5mm below the nail and ending 3-4mm away from the edge, leaving it intact. The skin is then removed, and the wound is left open to heal by itself. Aftercare typically involves soaking the toe 3 times per day in warm water for 15 to 20 minutes. Recovery time is approximately 4 to 6 weeks.
- The Syme Procedure – In this procedure, the nail matrix is completely removed as a permanent solution to preventing ingrown toenails from occurring in the future. Some skin may be transferred from another part of the body to fill in any resulting deficiencies. Unlike the Vandenbos procedure, the toe is held together with stitches to help facilitate healing. It is highly effective. However, recovery time takes over 2 months.
- Phenolisation – This surgery uses a chemical called phenol to destroy the nail matrix. This basically cauterizes the area and prevents the part of the nail that was removed from growing back. In a small percentage of cases, the phenol doesn’t completely destroy the nail matrix and the nail regrows in about 4 to 6 months.
How Much Does Surgery Cost?
The average cost of toenail surgery is between $260 and $500. However, the amount you will pay will depend on where you live and the doctor who performs the procedure. However, this type of surgery is typically covered by health insurance plans, so you may only be responsible for paying a copayment if you are insured.
How long it takes to recover from surgery depends on the type of surgery you have. If the doctor only removed the nail from the skin, then it usually only takes about a week for the toe to heal from the procedure. In fact, you should see improvement within the first 24 hours after leaving the doctor’s office or hospital.
On the other hand, it can take three weeks or more to heal from more invasive surgery such as a matricectomy. Additionally, the amount of time it takes for pain or discomfort to go away and the length of time you have to wait before you can return to your normal activities may differ. For instance, the pain may subside after a week but you may not be able to stand for long periods of time until two weeks after the surgery.
Although each situation is different, here is the general timeline for recovering from toenail surgery:
- Generally, you’ll still be able to walk on your own starting from the first day. However, you should have someone drive you home after the surgery if you had the operation on your right foot.
- Patients who only had the nail removed from the flesh without damaging the nail matrix will typically heal within 7 to 14 days.
- It may take 2 to 8 weeks for people who’ve had surgery to remove part or the entire nail and skin to heal, especially if they develop an infection.
- People who have surgeries that include destroying the nail matrix typically require 8 weeks or more to recover.
Other factors such as stress and physical activity can also impact recovery times.
If an ingrown toenail is left untreated, it can cause an infection in the bone (osteomyelitis). There isn’t always a sign that this has occurred, but you may experience fever or chills, irritability, pain, swelling, and redness in the infected area. Typically, a doctor will perform an x-ray to determine if the infection has spread to your bones.
Additionally, for people that have conditions that affects the circulation in the legs such as diabetes or heart disease, an ingrown toenail can become infected because of the poor and slow healing caused by the reduced blood flow. This may lead to gangrene (tissue death), which may require surgical removal of the affected tissue up and including amputation.