Definition & Overview

An ingrown toenail, also known as onychocryptosis, is one of the most common nail disorders. When left untreated, it can cause pain, walking difficulties, and infection. The condition can be addressed using various techniques such as debridement, partial or complete nail avulsion, and wedge resection. Wedge resection is one of the most commonly used techniques and involves removing only the affected part of the nail.

Who Should Undergo and Expected Results

The procedure is for patients with an ingrown nail or the nail that has grown into the skin around it. The condition is often caused by:

  • Improper nail cutting techniques
  • Tight-fitting shoes or socks
  • Trauma or injury to the toenail
  • Thickening of the nail plate
  • Deformed toenails (such as pincer-shaped toenails)
  • Subungual exostosis


Although an ingrown can affect patients of all ages, it is more common in men than women and those who are between 14 and 25 years old.

Aside from being painful, an ingrown also has the tendency to be recurrent and to cause an infection unless it is properly treated. The most effective treatment is the surgical removal of the ingrown nail, which can be done in many ways. Many podiatrists prefer the wedge resection technique especially when the problem is not severe enough to warrant a complete nail avulsion. Instead of removing the entire nail, a wedge resection simply removes the part of the affected nail. Studies show that minor surgical removal of ingrown toenails, including wedge resection, has a 95% success rate with a quick recovery period.

As wedge resection does not guarantee against recurrence, most podiatrists perform the procedure in conjunction with matrix sterilisation with phenol application that helps keep the nail from growing back. The combined procedure has an almost 100% success rate.

How is the Procedure Performed?

The procedure is performed under local anaesthesia, which is injected into the affected area. Once the area is numb, the podiatric surgeon will cut away the part of the nail that is growing into the skin and infection is drained. The whole procedure may take anywhere between thirty to forty-five minutes.

Due to the use of local anaesthesia, the procedure is generally painless. Patients also report little to no pain after the procedure, and their ability or pattern of walking is not affected. They may, however, be asked to wear loose-fitting shoes during the first few days following the procedure.

Patients are generally able to return to their normal activities the day after and are given instructions for wound care and medications, if necessary. Most patients are given antibiotics, which can be either oral or topical, to prevent an infection.

Possible Risks and Complications

A wedge resection of the nail fold, when used for the treatment of an ingrown toenail, is a simple, pain-free procedure. However, as a minor surgical procedure, it still has some potential risks and complications, which include:

  • Narrowing of the toenail
  • Infection
  • Bleeding
  • Anaphylaxis, or an allergic reaction to the anaesthesia used

    References:

  • Bryant A, Knox A. “Ingrown toenails: The role of the GP.” RACGP. 2015; 44(3): 102-105. http://www.racgp.org.au/afp/2015/march/ingrown-toenails-the-role-of-the-gp/

  • Zuber TJ. “Ingrown toenail removal.” Am Fam Physician. 2002 Jun 15;65(12):2547-2550. http://www.aafp.org/afp/2002/0615/p2547.html

  • Mousavi SR, Khoshnevice J. “A new surgical technique for ingrown toenail.” ISRN Surgery. 2012; 438915. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3359688/

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