Ingrown toenails - there is a permanent solution

If you've ever had an ingrown toenail, you know they can be quite painful, especially in shoes. But they can also become infected and that opens up a whole other can of worms.

First up, it's not always your fault you get them. Sure, if you cut them poorly you increase your chances of developing an ingrown toenail, as the spike left behind grows forward. But some people are just more prone to them. Genetics. Curvy nails, fleshy toes, or a combination of both are a recipe for ingrown nails no matter how careful you are.

Playing sport, especially kicking or sudden stops puts pressure on the nails. Downhill running. Tight shoes, steel cap boots, pointy high heels can all push the nail into the flesh more.

Or maybe you just stubbed your toe and ripped the nail back.

Ask Google, or your Neighbour and they'll tell you to cut your nails straight across. Sound advice, for most. But some, like those mentioned above do need to put a slight curve on the corners to avoid a sharp point. Just don't fall into the trap of cutting the corner of the nail half way down the nail, otherwise you increase the chances of the leading edge digging into the flesh as it grows forward again. Definitely don't dig halfway down and rip the edge out or else you risk leaving a sharp spike behind.

If you get a painful ingrown toenail and do want to attempt to remove the offending spike yourself, the sooner the better. Before the skin swells. Make sure you clean the area first, use disinfected instruments and apply some antiseptic cream and a Band-Aid afterwards. Keep it clean for a few days in case the nail had exposed the flesh. Seek doctor's opinion re antibiotics if really infected. If it is almost too painful to cut, trim a little, dress it up and try again tomorrow. Hopefully by then a little bit of the pain and swelling has gone down enough to have another attempt.

Or better still, come straight to a Podiatrist who has the expertise, the right quality equipment and can attack it from a better angle. Podiatrists also have strict sterilisation standards to follow, eliminating the chance of infecting an already painful toe. Whatever you do, do not go to a nail salon at the shopping centre, their instruments aren't clean. If they cut you, the odds of infection skyrocket.

There are patients that require a Podiatrist's attention on a semi regular basis for their ingrown toenails. Despite our skill set, and relieving the issue, it's only temporary and the nail just keeps ingrowing as it grows out again. In these instances, i advise my patients to consider a permanent solution.

• Nail surgery (Partial nail avulsion with phenol matrix sterilisation).

Basically, we cut out the offending strip of nail out parallel to the flesh and cauterize (kill off) that part of the nail bed, so the offending curved or spikey nail never returns.

There is minimal bleeding as we gently elevate the nail and don't cut the flesh, preferring to 'burn' the nail bed with an acid called phenol. The majority of patients don't require panadol or any pain relief afterwards. The swollen flesh settles, and the new edge no longer irritates the toe. The original nail groove closes over, reducing obvious signs of the procedure. For aesthetic reasons we take the minimum amount of nail to still be effective.

It's a safe and successful procedure done under local anesthetic in the treatment room. I've done hundreds of them. The only downside is keeping the toe dressed and clean for a couple of weeks till the wound heals.

This is not a procedure we rush into first time a patient gets an ingrown toenail (unless it resembles something out of a horror show), but is a great option for those suffering regular ingrown nails. Why suffer the rest of your life?

We can do a single edge, both edges of a nail, or even remove the whole nail is certain cases.

*Diabetics need to be extra careful with footcare and infections. Although the nail operation wound may take a little longer to heal for them, in many cases we are still better off doing the procedure now whilst the patient is able, rather than risk complications of an infected ingrown nail later in life (when circulation and circumstances are worse).