Onychocryptosis, commonly known as an ingrown toenail, is a painful condition where the edge of the nail plate penetrates the surrounding soft skin, or periungual tissue. This mechanical irritation often leads to inflammation, swelling, and can quickly progress to a localized infection. The big toe (hallux) is the most frequently affected digit, causing considerable discomfort and making walking difficult. A podiatrist, as a specialist in foot and ankle conditions, is best equipped to manage and resolve this problem safely and effectively.
Initial Assessment and Determining Severity
A podiatrist’s first step involves taking a comprehensive patient history to understand the duration of symptoms and any self-treatment attempts. They will inquire about relevant medical conditions, such as diabetes or poor circulation, which could affect healing and influence the treatment plan. A physical examination then determines the severity of the condition, which is often classified into stages.
Mild cases (Stage I) typically present with localized redness, swelling, and pain when pressure is applied. Moderate cases (Stage II) include increased inflammation and the presence of a local infection with potential discharge. The most severe presentation (Stage III) involves chronic inflammation and the formation of hypertrophic granulation tissue, an overgrown skin mass where the nail embeds into the flesh. This careful assessment guides the podiatrist in deciding whether conservative care or a minor surgical procedure is appropriate.
Conservative Management Before Surgery
For mild to moderate ingrown toenails without severe infection, a podiatrist may first recommend conservative management to alleviate symptoms. They may perform a specialized procedure to carefully trim the offending nail corner that is digging into the skin. This in-office trimming provides immediate relief by removing the source of irritation.
Another technique involves mechanical separation, such as nail packing, where a small wisp of cotton or dental floss is carefully placed under the ingrown nail edge. This lifts the nail plate away from the skin fold, encouraging the nail to grow over the skin rather than into it. If a secondary bacterial infection is present, the podiatrist may prescribe oral antibiotics. However, these medications treat the infection but do not resolve the underlying mechanical issue.
Minor Surgical Procedures Performed
When conservative treatments fail, or for advanced Stage II and Stage III ingrown toenails, a minor surgical procedure is the definitive solution. The procedure, performed in the podiatrist’s office, begins with a digital block, where a local anesthetic is injected at the base of the toe to numb the area. This ensures the patient experiences no pain during the removal of the problematic nail section.
Once the toe is anesthetized, the podiatrist performs a Partial Nail Avulsion (PNA) by using a specialized instrument to remove only the small, ingrown portion of the nail plate, leaving the majority of the healthy nail intact. The offending sliver of nail is removed all the way back to the nail root, or matrix. This partial removal immediately alleviates the pressure and irritation on the skin fold.
To prevent the removed section of nail from growing back, a Chemical Matrixectomy is typically performed immediately following the PNA. A chemical agent, most commonly Phenol, is applied directly to the exposed nail matrix tissue. The Phenol application permanently destroys the cells responsible for nail growth in that specific, narrow area. This two-step process provides a long-term resolution for recurrent ingrown toenails.
Recovery and Preventing Recurrence
Following the minor surgical procedure, the podiatrist applies a sterile dressing to the toe, which should remain clean and dry for the initial 24 to 48 hours. Patients are instructed to elevate the foot for the first day to minimize swelling and manage discomfort with over-the-counter pain medication. Dressing changes typically begin a couple of days post-procedure and involve gently soaking the toe in warm water before applying a fresh, sterile dressing.
The expected healing time is generally between two and four weeks, during which some mild drainage is common due to the chemical application. To prevent future issues, the podiatrist provides guidance on long-term prevention strategies. This includes adopting the correct nail clipping technique, which requires trimming the toenails straight across without rounding the corners. Choosing appropriate footwear is also important, specifically shoes with a wide toe box that do not compress the toes. Avoiding tight or narrow shoes reduces the pressure that can force the nail into the surrounding skin.