Partial Nail Avulsion

Podiatrist Treatment for Ingrown Toenail

If you are suffering the pain and discomfort of an ingrown toenail, your local podiatrist is the best place to seek treatment, rather than ‘Dr Google’, your local chemist or GP!

That’s because a podiatrist is something of an expert in the care and treatment of feet. After all, they’ve usually spent a minimum of four years at university learning all about the feet and lower limbs, and in Australia they are required to update their knowledge regularly as part of their registration requirements.

Causes of Ingrown Toenail

Known medically as onychocryptosis, some people are unfortunately born with a tendency to suffer from ingrown toenails; it can also be common in children. They may naturally have toenails with high curves, or fan shaped nails (narrow at the base and get wider as they grow out), both of which are more likely to lead to problems.

However there are a number of other possible causes:

• Ill Fitting Footwear – An ingrown toenail may develop if the shoe is not long enough. When we are walking or running, our foot naturally expands to fit the shoe. The secret to getting the best fit for new shoes, is to use a measuring device (known as a Brannock) to find the length of the foot, and then add a complete size. This allows for foot expansion so the toenails are not constantly hitting the toe box, which can lead to damage such as bruising or an ingrown toenail.
• Trauma – A blow or kick to the foot, for example when playing football or practising martial arts, can damage the toenail area. Or if you’ve ever dropped something on your toenail, you will know it goes black and blue and may even fall off eventually. When the new toenail grows in, it is usually more curved so the edges become sore and ingrown.
• Infection – Fungal nail infections can be nasty, causing the nail to thicken, change shape and look unsightly. Even once the fungus has been treated and eliminated, the sufferer will often find that their toenail is more likely to become ingrown.
• Growing Older and certain Health Conditions – Blood flow to the extremities (like our toes) tends to decrease as we age, or as a result of certain health conditions such as diabetes. This can change the shape of our nails and thus increase the chance of ingrown toenail.
• Medications – Young people taking a certain medication for acne, may experience ingrown toenail as a side effect.

When you see a podiatrist about your ingrown toenail, the first step will be to identify how it developed. Was it a one-off event, such as a kick, bump, or other trauma – or is it an ongoing problem?

Initial treatment aims to reduce the pain and inflammation, and prevent infection.

What is Partial Nail Avulsion?

If ingrown toenail becomes a recurring problem, you may need a minor procedure called a partial nail avulsion or PNA.

Most people wince at the thought of surgery for an ingrown toenail, because for many years treatment involved cutting into the groove at the side of the nail (the sulcus), scraping the nail bed and being stitched afterwards. However in the majority of cases this is no longer warranted.

Instead, a partial nail avulsion involves cauterising the nail using phenol. This is a less invasive treatment, using a local rather than a general anaesthetic which means:

• that PNA is a lot more affordable as it doesn’t require an anaesthesiologist;
• and that recovery is less painful, and a lot quicker.

Partial Nail Avulsion: What to Expect

Before the procedure: You will be carefully assessed to ensure suitability for PNA treatment for your ingrown toenail. For example, partial nail avulsion is not usually recommended for diabetics, people with kidney or liver problems, or if you are taking blood thinners. Your podiatrist will explain the procedure to you, encourage you to ask questions, and provide you with pamphlets to read at home.

The room is well prepped and instruments are sterilised.

During the Procedure: Two podiatrists are required by law – one maintains a sterile field and performs the procedure; the other is non sterile (to reduce any chance of cross infection), and is there to monitor your comfort levels and step you through the process. The whole procedure usually takes less than an hour.

You will be given instructions on aftercare, and the toenail should be dry and you should be feeling comfortable by the time you leave the clinic.

Because a local anaesthetic has been administered, we ask that a family member, relative or friend take you home. We also supply data about the amount of anaesthetic used, just in case you are involved in an incident (eg car accident) and need further anaesthetic in the next 24 hours.

Recovery and Aftercare

We recommend you keep the nail dry for two days, and keep your foot elevated; usually paracetamol is all that is required for pain relief, as there has been no cutting or stitching.

A follow up consultation 2 days after the partial nail avulsion is covered in the initial fee, and allows your podiatrist to check for infection or any other problems. At this appointment you will be given dressings, antiseptic and further instructions on follow up care. Of course if there are any problems, please call us immediately, at no extra charge.

As with any medical procedure there are potential risks, the main one being infection. There is a very slight chance of regrowth; for the small number of clients who do not respond well to phenolisation (ie the nail regrows), your podiatrist will refer you to the appropriate practitioner for an excision procedure .

It might sound scary, but a partial nail avulsion should cause minimal disruption to your life, and provide an effective permanent solution (1).

Remember, when it comes to a painful ingrown toenail, make an appointment with a podiatrist at Trevor Lane Podiatry on 3207 4736 or use our online booking form.

1. https://ebm.bmj.com/content/5/1/26 – viewed 22.08.19