Surgery for Ingrown Toenails
Ingrown toenails can be painful and lead to infections when the nail grows into the surrounding skin. If your child’s ingrown toenail doesn’t improve with at-home treatments and usual medical care, surgery might be necessary to remove the part of the nail causing the problem.
When Should Surgery Be Considered?
Surgery may be recommended if other treatments haven’t worked or if your child’s toe continues to be painful and infected. It’s often done when the skin has grown too much over the nail, making it difficult for the problem to heal on its own.
What does surgery for Ingrown Toenails Involve?
During surgery, your child will be given general anaesthesia, so they will be asleep and won’t feel anything during the procedure. The area will also be numbed with a nerve block, meaning your child won’t feel pain for several hours after the surgery.
The steps in the surgery include:
- Antibiotics are given at the start of the procedure to prevent infection.
- The overgrown skin and the ingrown part of the nail are removed, exposing a raw area. This is sometimes called a Willett’s procedure.
- If needed, part of the nail bed is “ablated” (removed) to prevent future nail growth into the skin. This is called a wedge resection.
It usually takes 6-9 weeks for the toe to be completely normal again.
What Are the Risks of the Surgery?
As with any surgical procedure, ingrown toenail surgery carries some risks. Your surgeon will discuss these potential risks with you before the operation. The general risks include:
- Anaesthetic Risks: Complications related to anaesthesia are extremely rare, but may include breathing or airway issues during the procedure.
- Bleeding and Bruising: Some bleeding or bruising around the site of the surgery is normal. This typically resolves on its own within a few days.
- Infection: There is a small chance of infection in the surgical site. Infections can develop despite antibiotics but are typically easy to treat if caught early.
- Scarring: A scar will form where the skin and nail were removed. However, this is usually hidden due to the methods used and will fade over time.
- Nail Growth Issues: In cases where part of the nail bed is removed (wedge resection), the nail may grow back abnormally or not grow at all in that area. This is rare but can occur.
- Recurrence: If preventative measures are not followed after the surgery, there is a chance that the ingrown toenail could recur.
How Long Does the Operation Take?
The surgery usually takes about 20 minutes. Including the time for anaesthesia and recovery, you’ll be away from your child for about an hour. Once the surgery is complete and your child wakes up, you will be called into the recovery room to be with them.
What to Expect After the Surgery
After the surgery, your child will rest in the recovery room. They will be monitored to make sure they are comfortable and safe. Once they are ready, you can feed them, and you will be able to take them home.
Once home, your child should rest and keep the foot elevated for the first 2 days to help reduce swelling and pain. Avoid walking and activity in order to keep the foot elevated. Walking to, and sitting on the toilet is ok, but return to elevating the foot in between.
After 2-3 weeks, as the wound is healing, we will show you how to keep the nail up and out of the skin as it regrows to prevent recurrence. This is sometimes called ‘nail training’.
Wound Care and Dressings
A special silver-based dressing will be applied to the wound, which helps with infection and inflammation. The area will be wrapped with a crepe bandage to protect it. The foot should be elevated for the first two days to reduce swelling and ease discomfort.
You’ll need to plan for the following.
- Contact your GP or GP practice nurse who will assist with regular dressing changes. The first dressing change is about 5-7 days after surgery, and depending on how it looks, your GP will make plans accordingly.
- You will have an appointment in the following week with your surgeon, and regular follow-up checks afterwards to monitor healing – this may alternate with your GP appointments.
- After 2-3 weeks, you will be able to change the dressing at home instead of attending a doctor appointment. It can be useful to have some Betadine ointment at home that can be used to assist wound healing and prevent infection.
- Dressing changes will likely continue for about 6 weeks.
- You’ll be shown how to do the nail training to start at around 2-3 weeks after surgery. This usually requires some tape or cotton buds, but you’ll be shown what you need and what to do.
Pain Relief
Your child will receive pain relief in the operating room, which will last for several hours after the procedure. Once home, they may need paracetamol (e.g. Panadol) or ibuprofen (e.g. Nurofen) for a few days.
Keeping the foot elevated for the first two days will significantly help to reduce pain.
You can also help manage discomfort by distracting your child with quiet activities such as reading, drawing, playing board games or other engaging activities which can reduce the need for medications.
Pain Relief after Surgery
Your child will receive good pain relief in the operating room, that will last a few hours.
After the operation they will need paracetamol (eg, Panadol) and possibly ibuprofen (eg. Nurofen) for a few days. Please let your surgeon and anaesthetist know if your child has intolerances or allergies.
You can also help manage discomfort by distracting your child with quiet activities such as reading, drawing, playing board games or other engaging activities which can reduce the need for medications.
Normal Activity After Surgery
In the first two days, your child’s activity needs to be restricted to keep the foot elevated. Walking to and sitting on the toilet is ok but keep the foot elevated in between.
Your child will need to avoid certain activities during the recovery period:
- Your child will be able to move around but should keep their foot elevated when not walking.
- Bathing: Keep the dressings dry.
- School: Most children can return to school in 1-2 weeks.
- Sports: It’s usually safe to return to sports about 6 weeks after surgery, depending on how well the area is healing.
- Footwear: You may need large shoes to fit around the dressings. It’s best to avoid wearing shoes if possible. If returning to school, we can provide a letter to support wearing non-standard shoes. You will need to be careful of other children standing on your child’s foot!
Troubleshooting Common Issues
If your child’s foot is very sore or throbbing:
This often happens if the foot hasn’t been elevated enough in the first two days. Encourage your child to rest with their foot elevated and take pain relief as needed.
If the pain doesn’t improve, the dressing may need to be loosened. Call your surgeon or visit the emergency department for advice. The wrap dressing can often be undone, but the inner dressing should remain intact.
If the dressing becomes soiled:
If there is bleeding, and the dressing has become quite blood stained, please call your surgeon for further advice. If afterhours, you may need to go to the emergency as they will have the supplies and expertise to help at that time.
If the dressing is soiled from the outside, it often doesn’t reach the wound itself because so many layers of dressing are used. Call your surgeon and we can discuss further. If a GP appointment is convenient then that may work too.
When to Seek Medical Attention
You know your child best. If you have any concerns, please see your family doctor or call your surgeon. It’s important to seek medical attention if you notice any of the following:
- Increasing pain that doesn’t improve with pain relief.
- Fever higher than 38.2°C.
- Swelling or bleeding that gets worse.
- Vomiting or feed intolerance.
- Discharge or unusual bleeding from the wound.
Image Gallery for Patient Consultations
Our Paediatric Surgeons may use this image set during your consultation to explain conditions and treatments.
We welcome our referrers and other health professionals in the community to use these as well.
