Ingrown Toenail Surgery Sydney

What are Ingrown Toenails?

Ingrown toenails (Onychocryptosis) occur when the corner or side of the toenail grows directly into the adjacent skin, causing discomfort, pain, redness, inflammation and sometimes infection. It is a common issue that usually impacts the big toe and can affect people of any age. Although a minor discomfort at first, ingrown toenails can progress to infection and cause serious chronic issues depending on your medical history.

Our Sydney podiatrists effectively treat ingrown toenails for both adults and children. We provide a range of non-surgical treatments and surgical procedures to treat the affected foot and avoid recurring discomfort, pain, and long-term complications. For mild cases, we always explore conservative treatment options as a first step. We recommend surgical treatment options only when necessary, such as for chronic ingrown toenails, where a permanent solution would avoid continual discomfort and pain.

3 Stages of Ingrown Toenails

Stage 1: Acute symptoms (<2 weeks) with mild redness and swelling.
Stage 2: Progressed to an infection producing more pain and pus; there may also be a small amount of granulation (tissue growth).
Stage 3: Chronic symptoms (>2 weeks) with a pus-producing infection, tissue enlargement around the toenail and granulation tissue that is growing over the nail.

Management based on stage:

Stage 1: Non-surgical treatment, such as painlessly removing the corner of the nail (Partial nail avulsion), salty warm water soaks, and toe spacers.
Stage 2: Surgery may be indicated where non-surgical options fail.
Stage 3: Surgical treatment is highly likely to be the best option.

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Causes of Ingrown Toenails

There are several causes of ingrown toenails, including:

Improper nail trimming, e.g. cutting the nail too short or not straight across.
Incorrect footwear, e.g. wearing too tight shoes that crowd or put pressure on your toes.
Poor hygiene, e.g. sweaty feet make your skin softer and easier for the toenails to dig in.
Genetic predisposition, e.g having naturally curved edges or fan-shaped toenails.
Medical factors, e.g. fungal nail infections, certain medications, and diseases affecting circulation. People with diabetes or poor blood flow are at higher risk of infection and complications from any foot wound.
Poor foot biomechanics, which can be aided with custom orthotics.
Trauma/injury to the toenail, e.g. stubbing it.
Nail deformities, e.g. excessive thickness.
Bony prominence underneath the toenail.
Athletic activities.

Symptoms of Ingrown Toenails

Ingrown toenail symptoms include:

Pain and tenderness.
Swollen, red or inflamed skin.
Hardened skin around the nail.

Signs of an infected ingrown toenail include:

Pus or discharge from the wound.
Throbbing pain.
Fever.
Bleeding around the toenail.
Redness or warm skin around the toenail.

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Ingrown Toenail Treatment

Our team of Sydney podiatrists is highly experienced in providing non-surgical and surgical ingrown toenail interventions. We first perform a full assessment of the area, checking the nail and surrounding skin. We discuss your medical history and current medications, as well as the full history of your ingrown toenail problem. This will allow us to determine whether you require ingrown toenail surgery or if conservative treatments could be effective. We will also talk you through the risks and benefits of each treatment and answer any questions.

Non-Surgical Treatments

For early-stage or less severe cases, non-surgical professional care may be enough to resolve the issue without surgery.

Nail edge removal: We gently lift and trim the offending nail edge, using sterile tools, sometimes performed under local anaesthetic. This relieves pressure and encourages healing.
Debridement and pressure relief: Callus, debris or overgrown tissue may be removed to reduce inflammation around the nail fold.
Topical antibiotics or antiseptics: Antiseptic creams or antibiotic ointments if mild infection is present.

Surgical Treatments

Ingrown toenail surgery is often required when conservative treatments are ineffective, and the problem gets worse. Nail avulsion is a quick and effective treatment for ingrown toenails, allowing for a rapid improvement in symptoms. However, if you're genetically predisposed to ingrown toenails, the problem may likely recur.

There are two different types of nail avulsion:

Partial nail avulsion (PNA): Performed for early-stage ingrown toenails, where the nail is beginning to pierce the surrounding skin. Typically indicated for toenail trauma or damage, where a narrow strip of nail from base to tip is removed, and the chemical phenol is applied to the nail matrix to prevent regrowth on that side. This permanently narrows the width of the toenail and should prevent any further ingrown toenails.
Total nail avulsion (TNA): When the whole nail is severely deformed, and both sides repeatedly grow into the surrounding skin, the entire nail can be removed. Phenol is applied to the nail root to prevent regrowth of the damaged portion of the nail. This is performed in cases of chronic ingrown toenails and severe fungal infections to prevent recurring problematic toenails. In other cases, nail regrowth is possible, but may take up to 12 months.

The procedure itself takes approximately 60 minutes and is performed under local anaesthetic. The area will be numbed quickly, so you will feel absolutely no pain during the removal.

Once the removal is complete, we will dress your toe to keep it clean, and you will be ready to head home and relax.

Ingrown Toenail Removal Recovery

Following your ingrown toenail procedure, while your toe will be numb, you will still be able to walk out of the clinic. We recommend having someone take you home from the clinic to minimise any pain caused by using your foot.

We also provide detailed care instructions for keeping your toe clean. This includes keeping the dressing clean and dry for 1 - 2 days, and avoiding activity for the rest of the day to minimise pain and promote good healing. In most cases, you can resume normal activity the following day.

Ingrown toenail surgery causes minimal post-operative pain, usually lasting less than 24 hours. Mild throbbing pain or a small amount of bleeding can occur, but this is generally normal.

You will need to attend 2 to 3 follow-up appointments to check the healing progress, which are covered in the overall surgery cost. Your toe should be fully healed within 2 - 3 weeks, provided no complications occur. In most cases, there will be no signs of surgery or scars after this period.

What to Bring to My Appointment

Please bring the following to your appointment:

As we utilise local anaesthetic, we do not recommend driving to or home from the surgery. Please arrange for someone to drop you off and collect you after the procedure.
Open-toed shoes to wear after the procedure.
Although not necessary, some people find that bringing a book, headphones for music, or something else to distract during the surgery is helpful.

Do Not Ignore Ingrown Toenails

It is dangerous to ignore any signs of ingrown toenails, as the problem can progressively get worse. If ignored, an ingrown toenail may start to break the skin, allowing bacteria to enter the wound and leading to an infection. If left untreated, the skin may start to grow back over the ingrown part of the nail. This causes severe pain, swelling, and infection, and can lead to permanent nail deformities and chronic ingrown toenails that require invasive procedures to correct, such as nail removal. If you notice symptoms of an ingrown toenail, we recommend booking a consultation as soon as possible to discuss your treatment options.

Frequently Asked Questions

Is ingrown toenail surgery painful?

Surgery of any kind can be frightening or nerve-wracking. That's why we endeavour to provide a comfortable, pain-free experience to treat ingrown toenails. This effective procedure is performed under local anaesthetic, ensuring you do not feel any pain. Although there might be some discomfort from the initial injection and once the anaesthetic wears off, this can be managed with over-the-counter pain relief. Post-operative pain is usually minimal and lasts less than 24 hours.

Does ingrown toenail surgery hurt afterwards?

You may feel some discomfort or pain around the toe for a short period following the surgery, usually minimal and lasting less than 24 hours. However, the recovery will be nowhere near as painful as the ingrown toenail itself. Over-the-counter pain relief such as paracetamol will help with the pain.

What at-home treatments are available for ingrown toenails?

If your ingrown toenail is mild - no pus, severe pain or signs of spreading infection, then conservative treatments may assist in managing it at home. They aim to reduce pressure, ease pain and prevent infection.

Warm salt water soaks: Soaking your foot in warm, salty water 2-3 times a day can help reduce swelling, soften the skin of the toe, and relieve tenderness. Use a clean tub or bowl, add a spoonful of Epsom or sea salt and warm water, and soak for 15-20 minutes. Avoid adding too much salt; 1 teaspoon per cup of water is sufficient.
Pain relief: If the toe is sore or throbbing, over-the-counter pain relief such as paracetamol or ibuprofen may help reduce discomfort and inflammation. This can also ease pressure around the nail fold and make walking a bit more comfortable. Always follow the instructions on the label, and check with your GP or pharmacist before taking anything, especially if you have other health conditions or take regular medications.
Antiseptic: Apply a small amount of antiseptic solution after each soak, unless advised otherwise by your doctor or pharmacist. This can help keep the area clean and reduce the chance of infection.
Carefully trimming the toenail: If the nail isn't too deep and the surrounding skin looks healthy, you can try trimming straight across after soaking. Avoid rounding the corners or digging down the sides, as this is a common cause of recurring ingrown toenails. If trimming is painful or difficult, stop immediately and contact our podiatrists.
Wear open or loose footwear, and avoid tight-fitting shoes: Even a mild ingrown toenail can worsen if your shoes are pressing on the toe. Avoid pointy shoes, heels or socks that squeeze your toes. Instead, opt for soft sneakers, sandals, or slippers with a roomy toe box. If you are required to wear enclosed shoes, consider using a protective foam toe cap to reduce pressure.

If there is no improvement after a few days, or if you have diabetes, poor circulation, or nerve damage, or you notice pus, spreading redness, or worsening pain, stop home treatment immediately. Contact us or call our experienced podiatrists to book a proper assessment and consultation to address the issue early on and prevent further complications.

Does Medicare cover ingrown toenail surgery?

Typically no, but you may be eligible for a Medicare rebate for a podiatry consultation through the Chronic Disease Management (CDM) Plan from your GP.

Does private health insurance cover ingrown toenail surgery?

Private health insurance typically covers ingrown toenail surgery; however, it depends on your health fund and policy cover.

How long is recovery from ingrown toenail surgery?

Approximately 2 - 3 weeks on average.

What shoes to wear after ingrown toenail surgery?

Open-toed or loose-fitting shoes such as sandals or slippers, for at least 7 days following the surgery. Avoid tight-fitting shoes or high-heeled shoes.

How long should I take off work after ingrown toenail surgery?

You should be able to return to work the following day in an open or loose-fitting shoe.

How long after ingrown toenail surgery can I exercise?

You should wait approximately 1 - 2 weeks before exercising. If you feel any discomfort after the 2 weeks, then you will likely need to wait longer for it to heal.

How soon can you swim after ingrown toenail surgery?

Avoid swimming for at least 7 days following the ingrown toenail removal. After this period, dress the toe with a waterproof dressing for another 2 weeks. Getting the affected area wet too soon could cause infection, and avoid sandy beaches during the healing process.