An ingrowing toenail is one that pierces the flesh of the toe. It can feel as if you have a splinter, be extremely painful and inflamed or infected. In more severe cases, it can cause pus and bleeding. Ingrowing toenails most commonly affect the big toenail, but can affect the other toes too. Whereas a nail that is curling (involuted or convoluted) into the flesh, but isn’t actually piercing the skin, isn't an ingrowing toenail but can feel very painful and also appear red and inflamed as well.
Before you are seen by a podiatrist, you can relieve the discomfort by bathing your foot in a salty footbath which helps to prevent infection and reduces inflammation. Then apply a clean sterile dressing, especially if you have a discharge and rest your foot as much as possible.
How a podiatrist will treat you will depend largely on the severity of your condition:
For the most basic painful and irritable ingrowing toenail, the offending spike of nail will be removed and covered with an antiseptic dressing.
For toes too painful to touch, a local anaesthetic will be injected before removing the offending portion of nail.
For involuted nails, part of the nail that is curling into the flesh is removed and then the edges of the nail are filed to a smooth surface.
For any bleeding or discharge from an infection, or even excessive healing flesh (hypergranulation tissue) around the nail, antibiotics will be suggested from your GP to beat the infection as well as having the offending spike removed.
For those particularly prone to ingrowing toenails from underlying problems nail surgery (partial nail avulsion - PNA) may be recommended. This procedure is done under a local anaesthetic where 8-10% of the nail is removed (including the root) so that the nail permanently becomes slightly narrower. The chemical phenol cauterises the nail and prevents it regrowing in the corners. This is over 95% successful. You will, however, have to go back to your podiatrist for a number of re-dressings. After surgery, the overall appearance of the nail looks normal – to the extent that some people even forget which nail they’ve had done!