Ingrown Toenail (Paronychia) Surgery

An ingrown toenail (onychocryptosis) occurs when the side edge of a nail, usually on the big toe, becomes embedded in the adjacent skin. Constant pressure and irritation first cause redness and swelling, then bacteria establish themselves and inflammation develops; this inflammation of the nail fold is called paronychia. Over time, a raised area of red, bleeding tissue (granulation tissue) develops, which patients often describe as 'extra flesh'.

Common causes include cutting the nail too short or rounding its corners, narrow pointed shoes, prolonged sweaty or wet feet, nail trauma and an inherited tendency for the nail to curve across its width. Excess weight and prolonged standing increase pressure. Diabetes, poor circulation and immunosuppressive treatment can make the condition more severe.

Treatment depends on the affected nail edge, recurrence and degree of inflammation. Repeated ingrowth of the same nail relates to the width of that edge of the nail matrix; simply cutting the visible portion often allows the problem to return.

Symptoms generally progress gradually through three stages: redness and tenderness, inflammation and discharge, and raised tissue formation.

• Throbbing pain at the nail edge, with tenderness increased by socks or shoes
• Redness, swelling and warmth at the edge
• Yellowish discharge, odour and pus expressed with pressure
• Raised red tissue at the nail edge that bleeds easily
• Avoiding weight-bearing on the affected toe while walking

Diagnosis is made by inspection; most patients need no additional tests. Examination assesses the depth of ingrowth, extent of inflammation, overgrown tissue and nail curvature. Foot pulses and skin sensation are also checked; circulatory or sensory problems alter the treatment plan.

Nail discolouration, thickening and crumbling require assessment for fungal infection; recurrent, treatment-resistant or unusual lesions need differentiation from other skin disorders. Joint assessment with dermatology may be requested. An X-ray is taken if infection extending to bone is suspected.

If the ingrowing nail is recent and inflammation is superficial and limited, improvement without surgery is possible. The aim at this stage is to relieve pressure and allow the skin to heal.

• Washing the foot with warm water several times a day and drying it thoroughly
• Wear wide-toed shoes that do not press on the toe and cotton socks
• Cutting the nail straight, without rounding the corners or cutting it too short
• Antibiotic or antiseptic dressings when considered appropriate by the doctor
• Antibiotic treatment on medical advice if infection is significant

Surgery is used when inflammation recurs, raised tissue develops or the problem does not improve with care. It is performed in the clinic under local anaesthesia injected at the base of the toe (digital block); a brief sting may be felt during injection, but pain is not expected during the procedure afterwards. Numbing may be inadequate in markedly inflamed tissue, in which case an additional dose is given. Most patients walk home on the same day.

Removing only the ingrowing nail edge (partial nail avulsion) relieves pain quickly, but recurrence is common because the nail grows back in the same way. To reduce recurrence, narrowing the nail root (matrix) on that side is added: this is performed chemically (with phenol) or by surgically removing the edge of the matrix. The nail then grows slightly narrower and is less likely to dig into the skin. Any overgrown tissue is removed during the same procedure. Removing the entire nail is no longer the first choice; it is considered in selected circumstances.

A dressing is applied afterwards, and elevation and reduced pressure are advised initially. Several appointments are arranged for dressing changes and healing checks. The nail edge may take months to reach its final shape; this is expected.

Mild toe pain and oozing may occur in the first days after treatment; following the prescribed dressing routine helps healing. Most patients resume daily activities in comfortable shoes within a few days. Avoid swimming pools, the sea and prolonged wet conditions until the wound closes.

Narrowing the edge of the nail root is central to reducing recurrence; care habits also help: cutting straight across without digging into the corners, wearing sufficiently wide shoes and keeping feet dry. Sports shoes should leave a finger's width beyond the toes. Early assessment of recurrence helps prevent worsening inflammation.

Most ingrown toenails relate to care habits, so correct trimming and footwear are integral to treatment. Toenails should not be cut like fingernails: rounding the edges leaves the corners beneath the skin, allowing them to grow into it.

Toenails should be cut straight across while soft after bathing, leaving them slightly beyond the tip of the toe without digging into the corners. Sharp edges can be smoothed with a file. Shoes should leave approximately a finger's width beyond the toes, and the toe box should not be narrower than the widest part of the foot. Cotton socks, changing socks during the day and drying the feet thoroughly help protect sweaty skin.

Repeated impact on the nail in people who stand for long periods or play sport can also encourage ingrowth; running-shoe size and toe-box width therefore matter. You can book by telephone or WhatsApp at AC CLINIC in Altınordu, Ordu, to assess the severity of an ingrown toenail and plan a procedure if needed.

Diabetes may reduce sensation in the foot, allowing an ingrowing nail to progress unnoticed and cause a wound. Poor circulation slows healing. Even a small-looking ingrowing toenail in this group should be taken seriously, assessed early and not treated at home. Foot care, appropriate shoes and regular checks are preventive measures.

Rapidly spreading redness, severe swelling, fever, chills, colour change in a finger (blue or black discolouration), or widespread infection requires urgent assessment. The clinic is not a 7/24 emergency department; call 112 or attend the nearest hospital emergency department in these situations.