Footnotes / Blog

What Are Ingrown Toenails?

Ingrown toenails are one of the most satisfying conditions to treat in the office, as patients often experience immediate relief within 48 hours. There are two main types of ingrown toenails: infected and non-infected, each requiring different approaches for treatment. Regardless of the cause, all ingrown toenails share the same underlying issue: the nail plate digging into the skin at the side of the nail. Let’s explore the causes and treatment options for this common condition.

Causes of Ingrown Toenails

Ingrown toenails can be caused by several factors, including:

• Naturally Curved Nails (Incurvated Nails): Some individuals have nails that are more curved than others, making them more prone to ingrown toenails.
• Secondary Causes: Toenail fungus or trauma can cause nails to become incurvated over time.
• Pregnancy and Postpartum: Pregnant women or those who have recently given birth may experience pedal swelling, which increases the likelihood of ingrown toenails.
• Self-Trauma or Nail Parlors: Improper trimming, especially digging into the corners of the nail either by the individual or at nail salons, can also lead to this condition.

Treatment Options for Ingrown Toenails

There are three main treatment approaches for ingrown toenails, depending on the severity and presence of infection.

1. Slant Back Procedure: The slant back procedure is used for mild, non-infected cases of ingrown toenails. Typically, patients report pain at the front corner of the nail near the end of the toe. During the procedure:
   • The offending portion of the nail is removed using a special surgical blade.
   • The area is numbed with cold spray anesthesia, minimizing pain during the procedure.
2. Partial Nail Avulsion with or without Incision and Drainage: For more moderate to severe cases, particularly those with infection, a partial nail avulsion is performed. This procedure involves:
   • Numbing the affected toe with Lidocaine (a form of novocaine).
   • Using a nail splitter to remove a portion of the nail from the offending side, extending all the way back to the nail root.
   • If there is an abscess (an infection collection of fluid), it is drained completely. This procedure is ideal for ingrown toenails with infection.
3. Phenol and Alcohol Procedure: For recurrent ingrown toenails, the Phenol and Alcohol procedure is the most effective option. It is only done in the absence of infection and involves:
   • Removing the problematic portion of the nail, as in the partial nail avulsion procedure.
   • The nail matrix (which produces new nail growth) is then treated with Phenol, a special acid that kills the cells and prevents the nail from growing back in that area. This method is reserved for individuals with frequent recurrences of ingrown toenails.

Post-Operative Care

After these procedures, the post-operative period is typically painless. Patients are instructed to perform daily foot soaks for two weeks to promote healing. If infection is present, antibiotics may be prescribed.