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Ingrown Toenails

Hi. Simon here, a doctor at Preston Family Medical talking about ingrown toenails. I just performed a ingrown toenail wedge excision, called a Zadeks procedure, for a patient this week and it jogged my memory to talk about this health topic. So common however there are things we can do to prevent ingrown toenails, there’s things we can do to improve them if they started to go wrong and there’s things we can do if they’re really wrong and we are heading for surgery.

An important thing to say is that toenails are different fingernails and we need to cut them flat. So nice and straight as drawn on this picture, put out by John Murtagh, a famous Australian GP and GP educator.

ingrown toe

Toenails really do better if we’re cutting them straight across and we’re giving room for the corners of the toenail to grow out away from that soft, delicate skin alongside the nail.

We want shoes that have an adequate toe box where there’s plenty of room for the toe, in there it’s not getting squashed and pinched by sharp pointy toes. We want to keep it, feet clean, dry. We want to give the shoes and the feet time to breathe at times. Things you can do yourself if you’re starting to feel a pinch, is actually every night pushing down on the soft skin next to the nail, and pushing that tissue down away from the nail, allowing that corner of the nail to pop up free of the skin fold.

As on this picture, if we’re starting to get molding around toenails, we can stop them getting worse by supporting the edge of the nail with a little wisp of cotton under the nail or a soft plastic tube. Here I use a cut bit of a butterfly needle, which is nice and soft. The inside of biros apparently can be used if it’s a bit of a stiffer plastic and you can cut them with a hot paperclip and it just needs to be held in place with a drop of superglue, just standard hardware store superglue, nothing fancy and that just supports that broken corner of the toenail and lifts it up away from the irritated skin around the nail.

If we’re trying all these things, it’s really not winning, it could be time for a surgical fix. I always try and talk patients out of it and try all these other things first before we get to surgery because unfortunately it is painful when it’s not comfortable for you. But for some people it really is the fix. And I’ll talk about the two main options now.

Have a look at the video for a lovely picture of an ingrown toenail. After numbing the toe, and we do that by injecting some local anesthetic at the base of the toe to make sure the whole toe is nice and numb. A traditional wedge excision removes, as the name suggests, a wedge. And what’s removed is all this infected, inflamed skin. That’s where the name of the wedge comes from, as well as a portion of the infected nail and that is all removed. So this is the traditional wedge ex procedure called a Zadeks excision.

Part of the actual growing part of the nail, called the germinal matrix, is removed in that procedure as well. And as a result, you do end up with a slightly narrower big toe. The traditional Zadeks procedure tends to be a very good fix for difficult ingrown toenails and particularly if there’s an abnormality in the nail itself and it’s not going to grow out on its own. After removing the wedge, removing this part of the growing nail, a couple of stitches to close up, a dressing and we touch base again after loading you up with some pain relief.

The other procedure targets not so much removing the nail itself, but all this excess infected, inflamed tissue. And it’s sometimes called a procedure that targets overgrown toe skin. And that’s the Vandesbos procedure. Again, after numbing the toe with local anesthetic, there’s a removal of the infected, inflamed toe tissue, but the nail itself is not thinned down or removed. And by removing all this excess tissue, it allows this broken, fragile edge of the nail to start growing out and grow clear of the the nail again. So it can be an option where the nail itself is actually intact, but the trouble is all this excess, infected, inflamed, overgrown toe tissue. Recovery is similar, dressings and follow up to make sure things stay well.

So, thanks for reading that discussion about ingrown toenails. Always happy to talk about options here at Preston Family Medical. We’ve got other videos about various health topics on our YouTube and the website as well and if you’ve got any suggestions for other videos, just send them to the Facebook page. Thanks very much for reading.