Ingrown Toenail Treatment in Melbourne

1 of 6 · Symptoms

Symptoms & Warning Signs

Ingrown toenails progress through recognisable stages, and the stage largely determines the treatment. Early on there is pain and swelling along one side of the nail with no break in the skin. Next the skin breaks down, with discharge and often infection. Later, chronic inflammation thickens the nail fold and granulation tissue forms beside the nail.

The most reliable early clue is that pressure from the side of the toe hurts more than pressure from above.

• Sharp pain along one side of the nail, worse when squeezed
• Swelling, redness and tenderness of the skin fold beside the nail
• Pain from footwear, bedding or a sock seam on the toe
• Clear or yellow discharge, or a bad smell
• A visible spike or curved nail edge disappearing into the skin
• Red, moist tissue beside the nail that bleeds easily
• Throbbing that persists after the shoe is removed, suggesting infection

2 of 6 · Causes

What Causes Ingrown Toenails?

The two most common contributors are nail-cutting technique and footwear. Cutting down the side of the nail, or tearing at it, leaves a small spike that grows forward into the flesh. Cutting very short lets the skin at the tip bunch up in front of the nail.

Shoes and boots compress the toe from the sides, and sports with repeated deceleration drive it forwards into the toe box. Sweat softens the surrounding skin, which is why the problem is common in adolescents and athletes training in heat.

1. 01Cutting or picking down the sides, leaving a spike
2. 02Trimming the nail too short so skin rolls in front of it
3. 03Shoes or boots that are short or narrow across the toes
4. 04Sports with stopping, kicking or downhill running
5. 05Sweaty feet and prolonged moisture softening the nail fold
6. 06A naturally curved or involuted nail shape, often inherited
7. 07Trauma, or thickened nails that grow irregularly

3 of 6 · Assessment

Assessment & Diagnosis

The assessment establishes three things: what stage the nail is at, whether infection is present and needs medical management, and whether this is a first episode or a recurring pattern. Those answers decide whether conservative care is worth trying or whether a procedure is the sensible option.

Dr Steven Singh, Principal Podiatrist

01

History and medical screening

How long it has been painful, how many previous episodes, and what has been tried including home cutting and antibiotics. Diabetes, circulation, sensation, immune suppression and anticoagulants are asked about directly, along with anaesthetic and dressing allergies.

02

Examination

Steve inspects the nail shape and edge, looks for a retained spike, grades the inflammation, and checks for discharge, granulation tissue and thickening of the nail fold. Circulation and sensation are tested where the history warrants it.

03

Footwear and sport

Reviewed because they are often the reason a treated nail comes back. In runners and field-sport athletes, too little length or depth at the toe is a frequent culprit.

04

When imaging is needed

Rarely. An X-ray may be considered after significant trauma or if infection appears deeper than the skin. A pigmented or atypical nail change is referred for medical review rather than treated as an ingrown nail.

4 of 6 · Treatment

Treatment Options

Treatment falls into two categories, and the choice comes down to whether the offending nail edge can be dealt with without a procedure.

Where infection is present a procedure can often still go ahead, because removing the nail edge is what allows the infection to settle. If infection is spreading or you are unwell, we coordinate with your GP about antibiotics first.

1. 01Conservative care can resolve an episode but often buys time only
2. 02Total nail avulsion in selected cases, such as a badly damaged nail
3. 03Antiseptic and saltwater soaking as an adjunct, not a treatment alone
4. 04Follow-up dressing changes and a clear aftercare plan

5 of 6 · Recovery

What treatment involves and how long it takes

Conservative care often relieves pain immediately, and a mildly inflamed toe usually settles over one to two weeks. If it has not improved, or it returns, that is the signal to consider a procedure.

1. 1

   On the day

   Allow around 45 minutes to an hour. The ring block stings briefly, then the toe is numb and the procedure is not painful. Bring a roomy open shoe, and arrange a lift home if practical.

2. 2

   The first 24 hours

   Keep the foot elevated where you can and the dressing dry and intact. The anaesthetic wears off over several hours and discomfort is usually manageable with simple pain relief.

3. 3

   Dressings and healing

   First dressing change at 24 to 48 hours, then daily salt-water soaks and redressing until discharge stops. A phenolised toe commonly weeps clear or straw-coloured fluid for two to six weeks, which is normal.

4. 4

   Getting back to sport

   Most people return to desk work the next day, and enclosed shoes are comfortable within several days to a week. Running, sport and swimming are usually deferred around two to four weeks, until the site is dry and healed.

6 of 6 · Prevention

Prevention Tips

Prevention comes down to how the nail is cut and how much room the toe has. Cut straight across, leaving the corners visible rather than digging down the sides, and leave the free edge just past the flesh.

Check shoe length while standing, with about a thumb's width beyond the longest toe. Sports shoes are worth checking first, because feet swell during activity and a shoe that fits in the shop can be short at kilometre eight.

1. 01Cut nails straight across and do not cut down the sides
2. 02Leave the free edge just past the skin at the tip
3. 03Use nail nippers rather than tearing or picking
4. 04Check shoe length standing, a thumb's width beyond the longest toe