Ingrown Toenail Surgery Perth
What is an Ingrown Nail?
Onychocryptosis, or an ingrown nail, is a condition that involves the nail of a toe curving and penetrating the skin on the side of the nail. It is a common foot problem and can be debilitatingly painful. Once a nail has cut the side of the toe the wound can be infected leading to further complications in healing and higher levels of pain.1 Ingrown nails are common, mostly occur in the 1st toe (big toe, great toe, hallux), effect more males than females, and are more common in the 2nd and 3rd decades of life.2 Children can also suffer from ingrown nail and can be problematic to treat, because of the high levels of pain associated with this condition. Predisposing conditions are tight footwear, tight socks, excessive sweating, and trauma.3 Trauma to the nail is a common precursor to ingrown nail, but they can also develop in a chronic cycle characterised by a thickening of the skin at the side of the nail following repeated injury. In chronic cases the side of the toe can become permanently engorged and damaged.
Treatment can be conservative or surgical with a range of options to address the various aspect of ingrown nails. Generally, patients are satisfied with treatment and experience increased quality of life and resolution of pain and discomfort.4 If you have a red, swollen toe and pain associated with a problematic nail, if you have chronic ingrown nails or you are experiencing pain with normal activities and weight bearing that is affecting your daily or sporting activities your toe should be examined by a Podiatric Surgeon or podiatrist who are exclusively trained foot and ankle specialists. Dr Pocklington can provide expert assessment and all treatment options for ingrown nail, including surgical intervention under general anaesthetic.
How is an Ingrown Nail treated?
Ingrown nails can be treated conservatively or with surgical intervention. It is important to consider conservative treatment before pursuing surgical options, because often conservative treatment can significantly alleviate symptoms and in some cases resolve the condition.
Dr Pocklington is both a Podiatric Surgeon (foot and ankle specialist surgeon) and trained podiatrist with extensive understanding of the form and function of the foot before and after surgery. This includes consideration of conservative as well as surgical intervention and the overall function (biomechanics of your foot).
Conservative treatment for ingrown nail involves cutting the nail back, resolution of any bacterial infection and wound treatment. Preventative measures may be considered once the acute presentation has been resolved, for example shoe modification, taping and cutting technique. The goal of conservative treatment is to resolve the condition permanently. However, depending on the cause of the ingrown nail, this may not be possible via conservative methods.
When should I Consider Ingrown Nail Surgery?
If conservative measures are not able to alleviate your discomfort or if there is significant pain interfering with normal activities surgical intervention should be considered. Ingrown nails can become chronic over time with damage to surrounding soft tissue becoming more problematic. Surgical correction of ingrown nail seeks to permanently alter the structure of the nail and prevent recurrence.
The key result is reduction or resolution of pain and a healthy return to normal activities and footwear. As a Podiatric Surgeon, Dr Pocklington is a foot and ankle specialist trained extensively in procedures used to treat ingrown nail and can assist you in deciding whether surgery is right for you.
What does Ingrown Nail Surgery Involve?
There are two main procedures that can be performed to address ingrown nails. Each procedure is a form of partial nail removal (avulsion) and will alter the size and shape of your nail.
- Partial nail avulsion with chemical matricectomy
- Sharp nail wedge resection (Winograd procedure)
Both procedures involve a cut to your nail and toe to remove a portion of your nail and the destruction of a section of the nail matrix (the area of toe that the nail grows from) in order to cease nail growth in that area. In both cases your nail will be slightly thinner and therefore much less likely to become ingrown.
Each procedure is appropriate for certain presentations and severity of condition. Similarly, each has advantages and risks that Dr Pocklington will discuss with you in detail prior to your surgery. All procedures take between 10 and 20 minutes to perform. Anaesthetic injections are used to numb your foot locally in all cases. These procedures can be performed under local anaesthetic only or with an anaesthetist who will also provide either a general anaesthetic or IV sedation.
Care and Recovery After Surgery?
Usually lesser toe surgery is a day procedure allowing you to immediately weight bear on your foot in a stiff sole surgical shoe. Rarely, people stay overnight at a private hospital and return home the following day.
Pain relief after surgery can involve combinations of painkillers and anti-inflammatories, but the need for significant pain relief is infrequent. Paracetamol is usually all that is required.
Healing usually occurs 1 to 2 weeks after the surgery. Restricted activities for 3 to 4 days, including time off work or school may be required depending on the circumstances. Dressings are removed after 3 to 4 days, giving you an opportunity to see your progress and discuss it with Dr Pocklington. Dressings are then changed regularly and instructions will be given so you can change dressings at home, if possible and convenient. If sutures are used, they are removed after 1 to 2 weeks. The process of healing after surgery is important and requires ongoing attention from your surgeon. Dr Pocklington will monitor your progress while you heal to ensure function is returned to the foot and your life as soon as possible.
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- Vlahovic TC, Khan MT. The human papillomavirus and its role in plantar warts: a comprehensive review of diagnosis and management. Clinics in Podiatric Medicine and Surgery. 2016 Jul 1;33(3):337-53.
- Kilkenny M, Merlin K, Young R, Marks R. The prevalence of common skin conditions in Australian school students: 1. Common, plane and plantar viral warts. British Journal of Dermatology. 1998 May 1;138(5):840-5.
- Kilkenny M, Marks R. The descriptive epidemiology of warts in the community. Australasian journal of dermatology. 1996 May;37(2):80-6.
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