Ingrown toenails are very common. Sometimes they occur after a nail was cut too short, often they occur for no obvious reason. Ingrown toenails with infection usually require some degree of medical management, either antibiotics and soaking and/or removing a piece of nail to allow the infection to completely resolve. When ingrown toenails become recurrent a permanent procedure can be performed in our office to prevent the ingrown toenail from coming back.
The process is simple. A topical cold spray is applied to numb the skin after which a local anesthetic is injected very gently into the toe to cause minimal discomfort and after a few minutes complete numbness will occur. Special sterile surgical instruments are then used to remove a small piece of nail from the infected edge of the toenail. If a permanent procedure is being performed, the nail root in the area where this piece of nail was removed is then treated with a topical acid. This tries to kill the cells that give growth to that portion of the toenail. The toe is then flushed with rubbing alcohol or sterile saline ,topical antibiotic ointment is applied, and the toe is dressed in a sterile gauze dressing.
There is risk of infection as toenails are dirty however the toe is cleaned well prior to the procedure. When a non-permanent partial nail removal is performed, the expectation is that the nail will grow back with time. This may lead to a recurrence of ingrown toenail later on. If a permanent procedure is being performed, there is still a chance the nail will grow back, but this is a small chance. In patients who have poor circulation, diabetes, or a long-standing infected ingrown toenail, there is a chance for infection to move into the bone, this can result in need for IV or long-term antibiotics or in severe cases amputations. Overall non-permanent and permanent partial and complete nail removal is considered a safe and effective procedure when done properly and the benefits typically far outweigh the potential risks when dealing with an infected ingrown toenail. At the time of your consultation specific benefits and risks will be reviewed in the context of your personal health history. A consent will be reviewed and signed clearly showing what areas are to be treated and you will be given ample opportunity to ask questions and get answers.
After you undergo a toenail procedure, the toe will remain numb for potentially a couple more hours. Eventually the anesthetic will wear off, but even then the toe usually feels better than it did before the procedure. I typically recommend to my patient’s that if they have any discomfort, take what they would normally take for her headache. Call the office to let the doctor know if you should develop any increasing pain, concerning redness, pus or drainage, swelling, fevers, chills, or any other concerning symptoms possibly related to your procedure. Other postoperative instructions are also given at the time of your appointment. if you have lost them or you need another copy, click the appropriate link below.
Postop Partial Nail Avulsion Instructions — Instructions for Non-Permanent full or partial nail removal
Postop Permenant Partial Nail Avulsion Instructions — Instructions for Permanent full or partial nail removal