Educational paper for GP's on ingrowing toenails by Michael O'Neill published in Pulse GP magazine march 2014
This is one of the most common problems we treat.
Patients will often have had several courses of antibiotics, numerous sessions of Chiropody and may have had a persistent pain for months,or sometimes intermittent symptoms for years.
There are several causes of ingrowing toenails, and various levels of severity. (See Below)
The treatment of choice is often a Nail Wedge Resection procedure. This takes around 10 minutes and is performed under local anaesthetic. It involves removing a small section of nail and chemically destroying the part of the nail bed where it grows.
See the Surgical Handout for preoperative evaluation, procedure details, complications, risks and post operative care.
As a Podiatric Surgical Consultant Mr ONeill is covered by all major health providers to undertake this procedure BUPA, AXA, PPP, SIMPLY, WPA, NU,etc
PROCEDURE CODES FOR HEALTH INSURANCE
Phenolisation: chemical nail bed destruction S7010
Incisional: Nail bed removed by surgery S6400
NEW BUPA CODES JUNE 2012: Podiatric Surgeon Package Code: AA629
Download Mr O'Neill's Surgical Handout for Ingrowing Toenails
Following are some of the common causes of ingrowing toenails:
- Inherited: Some people grow very wide and rounded nail plate
- Poor Nail Care: The way you cut your nails may leave sharp spikes
- Footwear: Tight shoes may press on the side of the toenail
- Injury/infection: Changes the growing area of the nail bed.
Toenails take about nine months to grow from the nail base to the top of the toe.
Sometimes problems begin when pressure from footwear distorts the growth of the nail, or the nail is trimmed into the curved shape. This allows one of its vertical edges to pierce the groove in which it lies.
Type 1: Ingrowing Toenail (Classification by O'Neill 1985)
An ingrowing toenail often looks as though there is nothing wrong with the nail, but it hurts in shoes, to touch and sometimes even bed clothes cause pain. This is often due to a slight curviture of the nail, tight shoes or poor cutting techniques. Simple trimming by a chiropodist or podiatrist will usually help to resolve this problem. If not treated will often progress to a Type 3 Ingrowing toenail.
Type 2: Involuted Ingrowing Toenail
This problem is often seen in those over 50 when the nail has excessively curved, or sometimes following damage either from some type of trauma or following fungal nail infections. Areas of corns and hard skin build up in the nail borders, causing pain and sometimes becoming infected. If caught early podiatry/chiropody treatment is the management of choice or will often progress to Type 3
Most common is the infected and inflamed ingrowing toenail, sometimes very painful, the skin around the nail appears swollen and red and sometimes pus may be visible under the skin.
Type 3: Classical Ingrowing Toenail
This is the classical ingrowing toenail, often found in teenagers or poor management of Type 1 or 2 above. This type of nail problem can also be managed by a podiatrist, sometimes with local anaesthetic if painful.
Type 4: Infected Ingrowing Toenail
If the nail has become ingrown several times, or the shape of the nail is so badly deformed that it is likely to re-grow, a decision may be made to remove part of the nail root. The end result will produce a normal looking but slightly narrower nail.
If the nail has become very deformed or if removing side sections would achieve an unsatisfactory result then the final option is to remove all the toenail
Type 5: Both sides infected
Treatment is as above, but sometimes the nail plate may be removed initially and then the side sections removed a few months later due to the extensive infection.