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There are two types of ingrown toenails. A proper ingrown toenail involves a sharp piece of nail breaking the skin at the side of the nail. As the skin swells, it pushes further onto the nail imbedding it deeper. These toes will look painful with redness, swelling, pus and perhaps blood. When you see the podiatrist, they will take a very, very fine blade and cut a curve off the nail edge to remove the spike, shown by the curved shaded area on the left side of the first figure below. As a rough rule, if the spike is up high it can be removed quite easily without anaesthetic. If it is too low, an injection in the base of the toe – well away from the sore spot – may be required.

The other kind of ingrown toenail problem has a name no one much has heard of onychophosis. Although painful, they don‘t look sore like an infected toe does. These are very common and make up ~80% of the ingrown toenails that need treatment. In this condition, the nail is not stuck into the skin but rather a small nodule grows in the gutter of skin along side the nail. It is underneath the nail and very painful, like having a little pebble pushed under your nail would be very painful. The good news about these is that their removal is straight forward and only very rarely would require local anaesthetic. The nodules themselves have no nerve supply and so can be trimmed away without pain.Either of these problems could be short term or long term complaints. At the first visit to the podiatrist, the problem will be addressed and you will walk out with a much relieved toe.

If the problem was a one off one perhaps the result of a nail cutting accident that might be all that is required. If the underlying cause is a deformed nail that will cause the problem to occur over and over, a permanent solution by way of a nail wedge resection may be recommended for a later visit and should result in the eradication of the problem for life.

A nail resection can be done in three ways. Podiatrists almost exclusively use a method called chemical cauterization. What makes this method preferable is that it doesn‘t involve cutting the skin. Looking at the picture of the nail below, you can see the part of the nail that you are familiar with and a skirt under the skin at the base of the nail. After local anaesthetic is introduced at the base of the toe, a cut is made as shown with a special tool through the nail only. When this strip of nail comes out, a little pocket is left under the skin. A drop of chemical is put in there which kills the nail growing cells and that is the only injury to the toe. No stitches etc are required and the whole process is generally less painful than a mildly ingrown nail. Best of all, it lasts forever.

Partial nail avulsion

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