# Ingrown Toenail Management

## Overview

This module describes two conservative and one surgical treatment option for ingrown toenails.

## Indications

## Contraindications

## Patient information and consent

### How do I explain this procedure?

“Your toenail has become ingrown, which means that the corner or side of the toenail is pressing and cutting into the skin beside it, causing pain and putting you at risk of getting an infection. I will try to release the ingrown part, and if that does not work I may need to cut it out.”

### What can my patient expect?

“I will give you an injection for pain. If the ingrowing is not too severe, I will just put cotton or a small piece of plastic between the toenail and your skin to prevent it from progressing. If it’s severe or it keeps on happening, I will cut out a section of your toenail and destroy the part that makes the nail grow out there so that it won’t happen again. If I’ve cut away part of the nail, expect the wound to ooze a bit of clear fluid for a few weeks until it dries out.”

### What is my patient’s role?

“Let me know if you have any allergies or a bleeding tendency, use blood thinners, or have any medical conditions. Fearing blood or needles is normal, but tell me if you have fainted from it. Once we’re done, you’ll have to change the dressing in two days, and keep checking for signs of infection, like increasing redness, heat, swelling and pus.”

## Preparation

### Documentation

### Equipment

Conservative management:

Surgical management:

## Site & Positioning

Position the patient reclining with the knee bent and the foot flat on the bed.

## Procedure

### Conservative management

Follow medical asepsis with non-sterile gloves.

### Surgical management

Follow medical asepsis with sterile gloves.

## Troubleshooting

My patient has returned with an infection.

Treat the patient with a course of oral antibiotics covering skin flora.

I don’t have phenol available.

Without ablation of the matrix, the ingrown toenail is likely to recur. You may use silver nitrate sticks, but warn the patient that it might cause tattooing of the area. Alternatively, an experienced provider may excise the matrix mechanically, although this is an inferior treatment to chemical ablation and requires cautery, an assistant, and should preferably be done in theatre.

My patient has returned with a recurring ingrown nail despite ablation of the matrix.

Refer this patient to surgery for more radical management.

## Risks

## References