Treatment
The treatment for an ingrown toenail is determined by the severity of the problem. For mild cases non surgical treatments are the best choice. However, if the condition is moderate to severe, and non surgical treatment has failed then surgery is the next option.
Nonsurgical methods of treatment:
Apart from conservative methods available, there are several nonsurgical solutions available that can be used to treat an ingrown toenail. Below are some nonsurgical strategies that are normally practiced:
Packing method: During this method, a wedge shaped piece of nail is removed from the side of the nail. The nail is then slightly raised by placing cotton wool or gauze that has been dipped in antiseptic fluid, between the nail and the skin tissue. This procedure has an immediate pain relieving effect, but needs to be performed several times so that as the nail re-grows it doesn’t pierce the skin. This is the clinics method of choice.
Gutter splint method: This method separates the nail spicule from the skin fold. A cylindrical plastic tube is placed between nail edge and the skin fold by lifting the nail edge and sliding the gutter (tube) down to the base of the nail. The gutter can stay there till the nail grows enough to cut it. The tube is usually covered with a band and fixed with adhesive. The technique has reported fast pain relief.
Bracing method: In this techniques, small metal braces are used to pull the ingrown edges of the toenail away from soft skin tissues. The braces help to change the shape of nails after cutting the curved penetrating nail spicule. This practice is really helpful for patients who cannot undergo surgery and diabetic patients. Studies have shown that patients undergoing bracing treatment have prolonged pain relief.
Tapping technique: The most simple nonsurgical method to treat ingrown toenails is the tapping method. An adhesive tape is used to drag the skin fold away from the ingrown toenail so that the nail is prevented from digging into the lateral skin tissue. One end of tape is placed at the lateral skin tissue at the junction with the nail edge and whilst the remaining tape is wrapped around whole toe leaving out the toenail. The method also provides pain relief.
Use of antiseptics: Antiseptics solutions can reduce the risk of bacterial infection, and thus prevent the condition from worsening.
Reducing risk of fungal infections: If the cause is due to a fungal infection, then the appropriate treatment for fungal nail infections need to be used. This may be a topical medication or in some cases an oral medication. Terbinafine is an example of oral antifungal medication. This can potentially cause liver damage, so it should be taken with care.
Changing Angle and Thickness of nail: In this technique, surface of the nail is filed so that the nail remains thin and soft and the convex angle of toenail is reduced, thus leading to a reduction of symptoms.
Antibiotics: They can be either oral or topical. The antibiotics that are prescribed, check the growth of Staphylococcus bacteria which is a common infection linked to ingrown toenails.
Surgical methods of treatment
When conservative and nonsurgical treatments have failed, surgical methods can be used to cure ingrown toenails. Several techniques exist:
Nail avulsion: In this technique, under local anesthetic, excessive pus is drained out and then a longitudinal section of affected nail (3-5 mm) is cut and removed from the nail bed followed by destruction of the toenail matrix with a chemical called phenol. This will ensure that the removed section of nail will not grow again, and therefore stop the recurrence of the problem. The procedure will in most cases eliminate the problem from recurring. The affected toe is then bandaged and antibiotics are prescribed if there is an infection.
Permanent nail removal: Total nail avulsion or removal involve removing the entire nail, this is done if the nail is thick and pressing into the skin surrounding the toes.