What is this disease?

• when the side of the nail cuts into the skin next to the nail and becomes painful, it is known as “ingrowing toe nail”. The skin next to the nail may also become infected or inflamed. Commonly the big toe is affected, especially in teenagers and young adults

How it is diagnosed?

• It is diagnosed based upon history and clinical examination

How it is treated?

• It can be treated by non-operative means in initial phase. The principle is to keep the skin from growing over the edge of the nail. If the nail fold becomes infected, then antibiotics are also needed. In persistent ingrowing toe nail, surgery is needed.

When it should be operated?

• If ingrowing toe nail becomes persistent and creating recurrent problems, surgery will be needed.

Are there other alternative methods of treatment?

• Non operative means  include  methods to prevent skin from growing over the edge of the nail( gutter splint technique, cotton wick insertion, Bandaid method, dental floss technique etc.). It is successful in initial phase of ingrowing toe nail only.

What all I need to know before my child surgery?

• Read “All you need to know before your child's surgery” information booklet in website.

How is the surgery done?

• The usual procedure is done under local anaesthetic or under sedation ( especially in children between 8-15 years of age who are apprehensive of local anesthetic needle). The toenail is cut with scissors longways a few millimeters in from the offending edge, right up to the base of the toenail and the offending edge is then pulled out. Then nail matrix is destroyed either by mechanical or chemical cautery ( phenol, TCA etc.). The nail is then dressed after checking for bleeding.

• The other method does not touch the nail but the soft tissue enveloping the nail is excised widely in an elliptical manner. All the skin at the edge of the nail is removed. The wound is left open to close by secondary intention. Hpowever, it is not commonly used method.

Remarks

• For more details of surgery, contact your surgeon

Related Photographs and videos

• Few photographs of steps done by me  is given here for learning purposes