How do we manage an Ingrown nail? - Written by our Newcastle Podiatrist Blake
We commonly see Ingrown nails
We commonly say ingrown nails in the clinic here at Achieve Podiatry Newcastle. We get a lot of questions about the management and treatment of this pathology. This blog will be a resource for patients as well as an educational piece.
We will explain the three options that we generally recommend when an ingrown nail presents in the clinic.
Firstly, it's important to understand the anatomy of the nail because it plays a huge role in the long-term development and long term management of an ingrown nail. If you have a look at the photo below you will see a very detailed picture of the anatomy of a nail.
The first thing that we try to workout with an ingrown nail is if the growth is more distal or more proximal. Generally, that will tell us if more aggressive treatment is required such as a local anaesthetic or a nail surgery.
It's important to understand how long a nail has been ingrown for. We typically see people who have had ingrown nails for several years and have never been given many options. For your understanding and generally speaking, if an ingrown nail has occurred multiple times, it is more likely that it will benefit greatly from a nail surgery. Now, back to talking about if it's more proximal or more distal growth. What we mean by this is if the nail is ingrown at the furthest part or top half of the nail, treatment becomes less invasive. It makes it a lot easier to take out that part of the nail with a blade. By and large, this is usually pain free, but we can use a local anaesthetic if we need to.
If it is more the proximal growth (meaning closer to the nail matrix, see picture above) and it is growing all the way from the matrix which is underneath the skin, it means that it's very likely come back again no matter how much we take. Unless we take it out or stop it from growing down at the matrix, it will continue to in grow. This means when we see patients that have had a chronic history of ingrown nails that continued to come back, we are more likely to suggest a PNA sooner because it's a simple and easy fix and it’s the most long term solution.
What is a PNA?
A PNA or partial nail Avulsion is a surgery that results in the long term successful removal of an ingrown nail. We do them regularly at Achieve Podiatry Newcastle. It involves removing the part of the nail that is causing the pain all the way down at the bottom of the nail at the nail matrix. Firstly, we use a local anaesthetic to make the toe numb, we then remove a small portion of the nail all the way down to the matrix. We than use a chemical on that corner. This chemical stops the matrix from producing nail and as a result the part that was in growing is not able to grow. Now we generally take more nail than what is needed. We only put a small amount of chemical so the rest of the nail grows back as normal. In most cases it looks like there was never anything done and now we have no ingrown nail issues.
We can also do TNA which is the complete removal of the toenail, and is used when the nail is extremely curved thick and or damage. This method results in the permanent loss of the whole nail. We also do this procedure to severe fungal nails but we don’t use the chemical. This resets the nail growth and can generally result in the nail growing back in a nice healthy manner.
As with any local anaesthetic the injection part of the treatment can be uncomfortable, but it doesn't last long.
Once the anaesthetic is working the procedure is pain free. We will not start the treatment until you are completely numb.
The total appointment time can be anywhere between 45 to 60 minutes. This includes time for all paperwork to be completed, aesthetic to work and for you to relax. The procedure itself takes only about 15 minutes.
You will be able to put your shoes on afterwards however it can be more comfortable bringing sandals or slippers. You will be able to return to work or school the next day. Some people find that 24 hours rest is beneficial to allow proper wound healing, however, we generally recommend that you're OK to go back in a day. Partial nail avulsions can take on average, four weeks to heal completely. Total now avulsions take approximately 6 weeks, however some will heal quicker than others. Generally, return to activity can be done within the week.