HC Chang Orthopaedic Surgery | Singapore

Ingrown Toenails

Onychocryptosis, also known as unguis incarnates, or ingrown toenail is a common form of nail disease.

An ingrown toenail is a common condition in which the corner or side of one of your toenails grows into the soft flesh of the toe. Normal toenail growth should be vertical or outward toward the tip of the toe. The abnormal extension of the toenail pushes into the surrounding skin, causing discomfort.

A break in the skin causes inflammation and infection of the toe. The inflammation often causes more thickening of the nail skin fold, further exacerbating the problem. The protruding piece of nail keeps pushing into the skin, causing further injury and pain.

What Causes Ingrown Toenail?

Ill-fitting shoes are one of the main causes of ingrown toenails. The downward pressure from wearing shoes causes the sideways growing portion of nail to poke into or pinch off a small piece of skin at the outer edge of the toe.

Other common causes include cutting your toenails incorrectly.  Like many people, when you trim your toenails, you may taper the corners so that the nail curves with the shape of your toe. But this technique may encourage your toenail to grow into the skin of your toe. The sides of the nail curl down and dig into your skin.

Heredity can also be a factor to developing ingrown toenails. If you were born with nails that are too large for your toes or nails that naturally curve, you may be more at risk of developing ingrown toenails.

Injuries to the big toe may ensue with ingrown toenails. Bumping of an affected toe can produce sharp pain as the tissue is punctured further by the nail.

Some people are more prone than others to ingrown toenails.

• athletic adolescents and children
• congenital foot deformity and congenital toenail malformation
• very long toes or naturally short toes
• obesity and diabetes
• fungal nail disease
• prior nail surgery
• abnormal nail growths
• arthritis
• excessive foot sweating

How Do I Prevent Ingrown Toenails?

Trimming your nails correctly and wearing shoes that give your toes more room could help to prevent developing ingrown toenails. You should also trim your nails regularly, cutting them straight across the top prevent them from growing too long.

Ingrown toenails can be a recurring condition. Managing and altering your daily lifestyle can prevent that from occurring.

What are the Symptoms and Signs of Ingrown Toenail?

Symptoms of an ingrown nail include:

• Sensitivity to pressure of any kind, even the weight of bed sheets
• Pain along the margins of the nail
• Worsening of pain when wearing tight footwear
• Swelling at the base of the nail on the side of the ingrown toenail

By the very nature of the condition, ingrown nails become easily infected unless special care is taken to treat the condition early on and keep the area clean. Signs of infection include:

• Redness and swelling of the area around the nail
• Drainage of pus and watery discharge tinged with blood

How do I Treat Ingrown Toenail?

Nonsurgical Treatment

Ingrown toenails should be treated as soon as they are recognized. If they are recognized early (before infection sets in), home care may prevent the need for further treatment:

• Soak the foot in warm water 3-4 times daily.
• Keep the foot dry during the rest of the day.
• Wear comfortable shoes with adequate room for the toes. Consider wearing sandals until the condition clears up.
• Place cotton or waxed dental floss between the toe and the tissue beneath it. The cotton or Waxed dental floss should be changed every day.

If there is no improvement in 2-3 days, or if the condition worsens, call your doctor.

Surgical Treatment

Surgery is effective in eliminating the nail edge from growing inward and cutting into the fleshy folds as the toenail grows forward. Permanent removal of the nail may be advised for children with chronic, recurrent infected ingrown toenails.

Partially removing your nail:

For a more severe ingrown toenail, your doctor may trim or remove the ingrown portion of the nail. Before this procedure, your doctor may temporarily numb your toe by injecting it with an anaesthetic.

This procedure is called wedge resection of the nail. It does not affect the growing part of the nail. New nail will start growing after a while.

Removing nail and tissue:

For a recurrent ingrown toenail, your doctor may suggest removing a portion of your toenail along with the underlying tissue to prevent that part of your nail from growing back.

The germinal matrix (the part of the nail bed that grows the nail) is removed.  We remove only the portion of the germinal matrix that grows the nail that causes the problem.

This surgery is commonly termed “Zadik’s procedure”.

Post-Surgery Recovery

Approximate Timeline Summary for Ingrown Toenail Surgery Recovery:

• Day 1 – Regardless of which procedure you have, you will be able to walk out under your own power. Though you will probably be able to drive your vehicle just fine, you might want to consider having a friend or family member join you at the doctor’s office so that they can drive you home.
• 1-2 Weeks – Patients undergoing a partial toenail removal without disturbing the nail matrix can typically expect healing to occur over a period of 7-14 days
• 2-8 Weeks – Patients with particularly problematic ingrown toenail conditions may have extended recovery time frames, especially if infection interrupts the healing process
• 8+ Weeks – Patients requiring a full nail avulsion with destruction of the nail matrix may require more than 2 months of healing.

The toe has to be fully recovered before resuming foot or nail treatments of any kind on the affected toe.

For more information on treatment of ingrown toe-nails, please contact us at +65-683 666 36 or visit us at www.ortho.com.sg