Ingrown Toenail

A medical interview complements the examination to identify contributing factors (improper nail trimming, shoes that are too tight, repeated trauma, history of ingrown toenails).

In the majority of cases, no imaging is required, as the diagnosis is essentially clinical. Supplementary investigations may, however, be considered in specific situations, for example in the case of severe infection, frequent recurrence or a particular medical background (diabetes, circulatory disorders). This thorough diagnosis enables rapid referral of the patient towards the most appropriate management.

Other anatomical or medical factors may also contribute:

• An abnormality in toe position,
• Bone or joint conditions such as arthritis,
• Hallux valgus,
• Nail diseases such as onychomycosis (fungal nail infection),
• Poor blood circulation to the extremities (toes).

Identifying the precise cause or causes is essential to propose effective treatment, limit recurrence and, where necessary, refer the patient for specialist care.

Complication: Infected Ingrown Toenail

When an ingrown toenail is not treated or worsens, signs of an infected toe from an ingrown toenail may appear:

• Pulsating, continuous pain, even at rest,
• Local discharge, sometimes purulent,
• A “granuloma” or small inflamed lump,
• Difficulty wearing shoes or walking.

These ingrown toenail infection symptoms warrant a specialist medical assessment to provide prompt pain relief and prevent infectious complications.

Warning Signs

Certain warning signs should prompt you to seek help without delay:

• Persistence of inflammation beyond two days despite local care,
• Appearance of signs of infection: increasing pain, discharge, local warmth,
• Formation of a large red granuloma at the skin fold,
• Signs of lymphangitis (a tender red line tracking up the foot or calf) — this is a medical emergency.

In certain cases, when infection is confirmed or pain becomes disabling, targeted surgery for the ingrown toenail may prove necessary.

It is advisable to contact your GP promptly, ideally within days of discovering the ingrown toenail, particularly if you have diabetes, peripheral arterial disease, a heart valve condition, a neurological disorder or an immune system disorder. These medical backgrounds increase the risk of complications.

Monitoring the progression of an ingrown toenail is essential: some forms can become serious without appropriate management. An early medical assessment is therefore recommended.

Fix an Ingrown Toenail with Surgery

When the toenail is ingrown and infected, recurrent or causing significant pain, targeted surgery becomes necessary. Severe forms remain uncommon, but certain situations require prompt action to prevent the spread of infection.

A specialist consultation is essential if general or local signs suggestive of complications appear, such as:

• Fever,
• Dizziness,
• Lymphangitis.

Surgery is formally indicated when the inflammatory granuloma becomes red, purulent and painful. In such cases, the procedure must be carried out without delay by a foot specialist.

The most commonly used technique involves removing:

• A wedge of the nail using a cold blade,
• The adjacent infected tissue,
• The corresponding nail matrix (the base of the nail).

The procedure is performed under local anaesthesia, ensuring optimal patient comfort. Depending on the technique chosen, it may be carried out without sutures, with recovery generally being rapid.

Other Possible Procedures

Other methods may be proposed depending on the patient’s profile and the severity of the condition:

• Laser treatment, offering a simpler procedure with often lighter post-operative care,
• Semi-insulated electrode techniques targeting the nail matrix,
• Chemical methods, such as the use of phenol to destroy the responsible portion.

The choice of surgical technique depends on several factors: the severity of the ingrown toenail, the presence of infection, the patient’s history and their expectations.