Surgical correction for ingrown toenail

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What is an ingrown toenail?

An ingrown toenail is one where the edge or corner of the nail grows down and cuts into the adjacent skin of the toe, leading to the toe becoming red, swollen and tender (inflamed). The big toe is most likely to be affected, either on one or sometimes both sides. If left untreated, the inflammation can spread to the rest of the toe and the area becomes infected and may ooze pus. It becomes painful when walking and may smell unpleasant.

The most common reasons for ingrown toenails are:

• Tight-fitting shoes which cause the toes to be compressed together and put pressure
  the nail.
• Improper trimming of toenails which cause the corners of the nail to dig into the skin.
  Nails should be trimmed straight across, not rounded.
• Injuries near the nail, stubbing the toe, having the toe stepped or anything that causes the nail to be damaged repetitively (such as playing soccer).

If self-care and medical treatment are not sufficient then surgery will be needed to remove the nail.

There are different operations to correct ingrown toenails. The most successful operations are:

• Wedge resection – removing the edge of the nail with its nail bed, resulting in a slightly narrowed nail.
• Nail extraction and Phenotherapy: removal of the nail and destruction of the nail bed by using a chemical (phenol).

Before the operation

The operation to remove the toenail will depend on how ingrown it is, whether one or both sides are affected and whether there is evidence of infection. The Doctor will discuss with you at the Outpatients appointment the most appropriate operation for your child. The operation can be undertaken as a day case procedure.

To reduce the risk of infection:

• Wash the child’s affected foot, twice a day with soap and water. Keep the foot clean
  and dry during the rest of the day.
• Change socks daily and after sport activates.
• Do not wear tight-fitting shoes. Consider wearing sandals, if possible.

After the operation

Your child will be taken to the recovery room until ready to return to the ward. Every child is different some are awake and others are fast asleep when they return to the ward. An operation and anaesthetic can affect children in different ways. Your child may feel unwell for several hours afterwards. A nurse will be present to monitor their progress.
Your child can start drinking when awake. A snack box will be provided with food and drink.
Discharge home depends on your child’s recovery and can be from about two hours after
surgery. Before going home we like your child to be tolerating fluids, to be comfortable and be able to walk a short distance. We advise that your child has a quiet evening at home when discharged from hospital.

Pain relief (at home)

Your child may be uncomfortable for a few days after the operation. We will give you medicine to take home. Your child should take at least:

• Paracetamol (tablets or Calpol) 4 to 6 hourly for 4 days.
• Voltarol tablets twice a day for 2 to 4 days (reduces swelling).

An antibiotic such as Augmentin may be prescribed for 5 to 7 days if there is evidence of infection at operation.

Possible problems

Having a toenail removed is a common and generally safe procedure, the problems
that can occur include:

• Infection: antibiotics are given to reduce this risk especially if Infection might have
  been present prior to the operation If your child has a constantly raised temperature, contact your GP.
• Bleeding: regular bleeding through the bandages (contact your GP).
• If the nail bed is treated with phenol, inflammation can develop inside the toe
  causing the foot to swell. This is painful but rare. Your child may require anti-inflammatory drugs for the swelling.
• Although your surgeon will be experienced at performing this procedure, phenol
  treatment does not always work and your nail may grow again.

Care of the wound (at home)

• Your child should keep their foot elevated at all times when sitting. Wear open toe
  sandals and no socks when possible.
• Your child will have a dressing and bandage on their foot which should be kept clean
  and dry to reduce risk of infection.
• The dressing should be soaked off and re-applied by a nurse 3 days after the operation and then changed on alternate days. We will give you some dressings for the nurse to re-apply.

Dressing change

An appointment for the dressing change will be organised before your child leaves the hospital.
Date and time booked for change of dressing on:

The Children’s Community Nursing Team or the practice nurse at your GP can remove
the dressing after 3 days.

The stitches need to be removed about 10 to 14 days after the operation. The nurse undertaking the dressings will advise.

• Your child may have no stitches.
• Your child may bathe as normal, but you should keep the dressing dry.
• Your child may go back to school after a week, but should be off all sports and
  rough games for at least 4 to 6 weeks, unless otherwise instructed.

Please expect that the new nail will be an odd shape and colour, and won’t look the same as your other toenails.

For more information you may find this website on the Internet useful:

Patient UK

Royal Alexandra Children’s Hospital, Eastern Road, Brighton, BN2 5BE
Telephone 01273 696955