Ingrown Toenail – Causes, Symptoms and Treatment in Vienna

INGROWN TOENAILS (INGUIS INCARNATUS) MOSTLY AFFECT THE BIG TOE. THE INGROWN TOENAIL PRESSES INTO THE LATERAL NAIL FOLD OR SURROUNDING SKIN CAUSING PAIN OR INFLAMMATION. POSSIBLE CAUSES INCLUDE PREDISPOSITION, TIGHT SHOES, OR INCORRECT NAIL CUTTING.

READ ABOUT THE CAUSES AND TREATMENT OPTION HERE.

Photo: © Stephanie Eichler  - stock.adobe.com

• What are ingrown toenails? What are the symptoms?

• What are the causes?

• What type of treatment is available?

• How is ingrown toenail surgery performed?

• How do I prevent ingrown toenails?

• What helps at home – and where are the limits?

• How long does full recovery take?

• Is there any risk from an ingrown toenail?

• When should you see a doctor about an ingrown toenail?

What are ingrown toenails? What are the symptoms?

An ingrown toenail presses into the lateral nail fold (the surrounding skin), causing inflammation and swelling. The irritation causes granulation tissue to form and bacteria can enter the damaged and inflamed skin, which leads to further inflammation.

What are the causes?

Tight shoes or incorrect nail-cutting techniques encourage the development of ingrown toenails. Cutting toenails into an oval or rounded shape at the edges can cause pressure when wearing tight shoes, which often leads to the development of an ingrown toenail.

Some patients have a familial predisposition for ingrown nails. A wider nail bed can increase the risk of ingrown toenails.

What type of treatment is available?

At our practice at Vienna Central Station (1100 Vienna), we treat ingrown toenails both conservatively and surgically – from nail braces to phenol cauterization. Depending on severity, the following treatments may be considered:

• Professional foot care, tamponades or taping: for mild symptoms, to relieve pressure on the nail edge
• Nail correction brace (e.g. 3TO): gently lifts the nail and prevents further ingrowth
• Phenol cauterization: our preferred method for recurring problems – removal of the lateral part of the nail and chemical treatment of the matrix
• Wedge excision (Emmert procedure): only rarely and in exceptional cases – surgical removal of the nail edge and matrix

First and foremost, trained medical podiatrists are a good place to start. We have a team of trained professionals in our practice. They offer the following conservative treatment options in our center in Vienna:

Tamponades: The edge of the nail is carefully lifted, and a sterile compress strip is placed between the nail and the skin as a cushion.

Adhesive tape: Tape is attached so that it pulls the inflamed skin on the side of the nail away from the edge of the nail.

Nail clips: These wire clips are placed on the nail and hooked behind one or both side edges of the nail by a podiatist. Pulling the brace lifts the nail a little.

If the problem is not brought under control through conservative measures such as braces, taping and tamponades, it is advisable to see a specialist dermatologist or surgeon.

There are several ways to surgically treat an ingrown toenail. In the case of minor interventions, the inflamed tissue on the side of the nail is removed (nail wall resection). This gives the nail more space. Sometimes only the ingrown nail edge is cut away (wedge resection).

If ingrown nails repeatedly cause problems, there is the possibility of nail narrowing. At our practice, we primarily use phenol cauterization for this:

In phenol cauterization (phenol matricectomy), first the affected lateral part of the nail is removed. The corresponding area of the growth zone (matrix) is then treated chemically with phenol so that the nail no longer grows back at this point. As a result, the nail becomes slightly narrower. This procedure can easily be carried out in the practice and, according to studies, has a lower recurrence rate than surgery alone. The wound usually heals within several weeks and may weep slightly during this time. Regular wound care supports healing. Because the treated part of the matrix is permanently destroyed, the risk of recurrence is lower than after removal of the nail edge alone – although renewed ingrowth cannot be ruled out completely.

Only rarely and in exceptional cases is a nail wedge excision (Emmert procedure) needed. It removes the affected nail and its growth zone (matrix). After the operation, the nail grows back smaller and, as a rule, there is no renewed ingrowth.

Local anaesthetic is usually sufficient for these types of treatment. The anaesthetic is injected into the toe on both sides temporarily paralysing the nerves. To prevent the area from bleeding too much during the operation, a rubber band is tied around the toe.

Possible complications during and after an operation are infections or healing complications of the wound, problems with nail growth or bleeding.

Book your ingrown toenail appointment in Viennahere.

How is ingrown toenail surgery performed?

The procedure is performed on an outpatient basis under local anaesthesia directly at our practice in Vienna. After the toe has been numbed, the affected lateral part of the nail is removed. In most cases, the corresponding growth zone (matrix) is then treated chemically with phenol (phenol cauterization) so that the nail does not grow in again at this point. Surgical removal of the matrix (Emmert procedure) is only necessary in exceptional cases. Any granulation tissue (“proud flesh”) is treated at the same time.

The procedure usually takes only a short time. Afterwards, you will receive a dressing and detailed instructions on wound care. Comfortable, open or wide shoes make the first few days easier. Follow-up appointments help monitor healing.

How do I prevent ingrown toenails?

The right footwear and optimal cutting of the nails are important. In the event of an acute occurrence, you can first try to cleanse the painful area in a warm, soapy or tannin foot bath and soak for about 10 to 20 minutes. In some cases, iodine baths can also be taken - but with caution, as iodine can interfere with wound healing. The affected foot should be dried thoroughly after the bath. Antiseptic and anti-inflammatory ointments (iodine) prevent infections and can soothe the skin.

What helps at home – and where are the limits?

For mild symptoms without inflammation, simple measures can help: warm foot baths, well-fitting shoes that do not press, and cutting the nail straight across without rounding the corners.

However, self-treatment has clear limits. Do not cut deep into the corners of the nail yourself – this can make ingrowth worse and encourage infection. If you notice redness, pus, severe pain or if symptoms do not improve after a few days, you should seek medical advice. If you have diabetes or circulatory disorders, we recommend avoiding self-treatment.

How long does full recovery take?

Since nails grow only slowly, treatment takes a certain amount of time. Those affected should therefore be patient, because depending on the findings and treatment method, it can take several weeks, sometimes even months, until the nail grows normally again. Comfortable shoes and the right cutting technique are important even after successful treatment.

Is there any risk from an ingrown toenail?

An ingrown toenail is very painful. The inflamed area can also serve as an entry point for other germs and subsequently lead to an infection. Elderly people in particular, as well as diabetics, are at risk because wound healing is poorer for them - partly due to the increased sugar.

When should you see a doctor about an ingrown toenail?

An infected ingrown toenail typically shows redness, swelling, tenderness and warmth at the nail edge. Over time, pus and excess granulation tissue may develop.

You should have an ingrown toenail examined by a doctor at the latest if you notice any of the following signs:

• Increasing redness and swelling
• Pus formation
• Severe or persistent pain
• Spreading inflammation, such as redness extending beyond the toe or fever

If you have diabetes or circulatory disorders, do not wait: wounds heal more poorly and infections can spread more quickly. In this case, have your toe examined by a dermatologist early on.

Dr. Gábor Bali is one of our physicians with extensive experience in the surgical treatment of ingrown toenails (phenol cauterization).

Dr. Lara Durakbaşa also has extensive surgical experience – from plastic and reconstructive surgery and dermatologic surgery at the Medical University Hospital Innsbruck – and also offers phenol cauterization.