Watch: Understanding Ingrown Toenails with Dr Damien Lafferty

Ingrown toenails (onychocryptosis) occur when the edge of a toenail grows into the surrounding skin, causing pain, redness, swelling and sometimes infection. This most often affects the big toe. At our Sydney podiatry clinics in Darlinghurst and Greenwhich, our podiatric surgeon, Dr Damien Lafferty offers comprehensive care for ingrown toenails – from gentle home remedies to advanced surgical solutions. This guide explains ingrown toenails’ causes and symptoms, outlines home treatments, details professional (podiatric) treatments including surgery, and describes recovery, aftercare, and special considerations for children and patients with diabetes.

Understanding Ingrown Toenails

An ingrown toenail happens when the side or corner of a toenail grows down into the skin beside it. This often tears or punctures the skin, leading to inflammation and sometimes infection. Common symptoms include pain, redness, swelling, and a hard callous of skin around the nail. If infection occurs, you may notice pus, bleeding, warmth or throbbing pain. Symptoms usually worsen over time rather than improve on their own.

What Causes Ingrown Toenails?

  • Improper nail trimming: Cutting toenails too short or tapering the corners creates sharp edges that dig into the skin.

  • Toe injury: Stubbing, dropping something on the toe, or repeated trauma (e.g. from sports) can trigger an ingrown nail.

  • Nail shape and hygiene: Naturally curved or fan-shaped nails and excessive moisture (sweaty feet) make the nail edge more likely to invade skin. Picking or tearing at the nail corner can also cause it. Ingrown toenails become more common with age as nails thicken.

  • Medical factors: Nail infections (fungal), certain medications, or diseases affecting circulation can contribute. Notably, people with diabetes or poor blood flow are at higher risk of infection and complications from any foot wound.

When to seek care: If you have an ingrown toenail that is very painful, shows signs of infection (redness, pus, fever), or you have diabetes or circulation problems, see a doctor or podiatrist promptly. Early assessment by a foot specialist can prevent serious infection.

Home (Conservative) Treatments for Ingrown Toenails

If your ingrown toenail is mild – meaning there’s no pus, severe pain, or signs of spreading infection, you may be able to manage it at home. These conservative treatments aim to reduce pressure, ease pain, and prevent infection.

When to Stop DIY

If there’s 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. Book with a podiatrist or podiatric surgeon for proper care. Always check with your GP or pharmacist before using any medication or antiseptic, especially if you have other health conditions.

Soaking your foot in warm, salty water 2–3 times a day helps reduce swelling, softens the skin, and relieves tenderness. Use a clean tub or bowl, add a spoonful of Epsom or sea salt, and soak for 15–20 minutes. Don’t use boiling water – warm is plenty. You can add a splash of antiseptic (like Betadine) if the skin looks irritated.

TIP: Avoid adding too much salt, about one teaspoon per cup of warm water is plenty. You can use a clean plastic tub or foot basin. Dry your foot gently afterwards with a soft towel.

After soaking, you can try to gently separate the nail from the inflamed skin by placing a tiny bit of sterile cotton or dental floss under the corner of the nail. This helps train it to grow above the skin instead of into it. Be gentle, if it’s too painful or deep, stop and seek professional help. Change the cotton after each soak to keep things clean.

TIP: If the nail is deeply embedded or bleeding, don’t attempt to lift it, you could cause more damage or introduce bacteria.

Apply a small amount of antiseptic cream, such as chlorhexidine or povidone iodine, after each soak, unless advised otherwise by your doctor or pharmacist. This can help keep the area clean and reduce the chance of infection. If the skin looks irritated but not infected, a barrier cream like zinc oxide or Sudocrem may help soothe the area and reduce friction from socks or shoes.

Ditch the tight shoes. Even a mild ingrown nail will get worse if your shoes are pressing on the toe. Opt for soft sneakers, sandals, or slippers with a roomy toe box. Avoid pointy shoes, heels, or socks that squeeze your toes together.

TIP: If you’re required to wear enclosed shoes at work, consider using a protective foam toe cap or surgical shoe temporarily to reduce pressure.

If the toe is sore or throbbing, over-the-counter pain relief like 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 stick to 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.

If the nail isn’t too deep and the skin around it looks healthy, you can try trimming it straight across after soaking. Use clean, straight-edge nail clippers, and avoid rounding the corners or digging down the sides, this is a common cause of recurring ingrown toenails. If trimming is painful or difficult, leave it and get help from a podiatrist.

Dr Damien Lafferty, a podiatric surgeon based in Darlinghurst and Greenwich, offers safe, in-clinic toenail management for adults and children – especially if the nail is too curved, thick, or embedded to manage at home.

Professional Treatment Options for Ingrown Toenails

If your ingrown toenail is persistent, painful, or has become infected, professional podiatric treatment is usually the most effective solution. At our Sydney podiatry clinics in Darlinghurst and Greenwich (HEALTHiClinic), we offer both non-surgical and minor surgical interventions – all performed under sterile conditions by Dr Damien Laffery, an experienced podiatrist and podiatric surgeon.

All treatments are performed under local anaesthetic, and we take a conservative approach,  only removing what’s necessary. Dr Lafferty’s goal is to relieve pain, prevent recurrence, and preserve the natural appearance of your toenail wherever possible.

Non-Surgical In-Clinic Treatments

Non-Surgical In-Clinic Treatments

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

  • Sterile nail edge removal: We gently lift and trim the offending nail edge using sterile tools under local anaesthetic cream. This relieves pressure and encourages healing.

  • Debridement & pressure relief: Callus, debris, or overgrown tissue may be removed to reduce inflammation around the nail fold.

  • Nail bracing or taping: In some cases, we apply orthonyxia (a nail brace) or special tape to guide the nail’s growth and reduce curvature over time.

  • Topical antibiotics or antiseptics: We may prescribe antiseptic creams or antibiotic ointments if mild infection is present.

Surgical Options (Performed In-Clinic)

When the ingrown portion is severe, infected, or keeps returning, minor surgery under local anaesthetic is the most effective long-term solution. All procedures are performed in our clinic, and most take under 30 minutes.

Common procedures include:

  • Partial Nail Avulsion with Phenol Matricectomy
    Only the problematic nail edge is removed, and phenol is applied to the nail matrix to prevent regrowth on that side. This is our most common and effective surgical treatment, with a high success rate and low recurrence.

  • Total Nail Avulsion
    In cases where the whole nail is severely deformed or both sides repeatedly ingrow, the entire nail can be removed. Regrowth is possible but may take up to 12 months.

  • Wedge Resection (Winograd Procedure)
    A wedge of nail and soft tissue is excised and sutured closed. This may be used when there’s overgrown skin or curved nails causing corner pressure.

  • Heat or Laser Matrixectomy
    Instead of phenol, we can use electrocautery or laser to destroy the nail matrix. This prevents regrowth while reducing chemical exposure.

What to Expect Before, During, and After Treatment

Having ingrown toenail surgery might sound daunting, but it’s a quick, low-risk procedure that can relieve pain almost immediately. At our Darlinghurst and Greenwich clinics, Dr Damien Lafferty and the team aim to make the process simple, comfortable, and stress-free, from start to finish. Here’s what to expect at each step.

Timeframe What to Expect
Day 0–2 Rest, keep the foot elevated. Leave the dressing intact and dry. Expect some mild throbbing once the anaesthetic wears off.
Days 3–7 You may start changing the dressing (as advised). Gentle showers okay. Light walking in soft footwear is fine.
Week 2 Pain and swelling should be mostly resolved. Most patients return to regular shoes. If stitches were used, they may be removed now.
Weeks 3–4 The toe is typically healed. Nail edges (if phenolised) won’t regrow. Resume full activity unless advised otherwise.
Months 2–12 If the whole nail was removed, it may take up to 12 months to grow back fully. The new nail may look slightly different in shape or thickness.

No fasting is required, and you can eat normally beforehand. We recommend wearing open-toed shoes on the day of your appointment and avoiding any creams or nail polish on the affected foot.

Dr Lafferty will examine the toe, explain the procedure, and confirm your consent. You’ll be given written aftercare instructions before you leave. You’ll also need someone to drive you home or plan to use a taxi, as it’s not recommended to drive immediately after local anaesthetic.

The toe will be cleaned and numbed with a small local anaesthetic injection. Most people report only a brief sting. Once numb, you won’t feel pain,  just some pressure or movement.

The procedure takes about 15–30 minutes depending on the severity. The ingrown nail edge (or full nail if needed) is removed, the area is treated with phenol or cautery if appropriate, and a sterile dressing is applied. You’ll be able to walk out of the clinic.

After the numbness wears off (usually a few hours), it’s normal to feel some throbbing or discomfort. This can usually be managed with paracetamol or ibuprofen  Dr Lafferty will give you instructions regarding any medications required.

You’ll need to keep the dressing clean and dry for the first 1–2 days. Most patients return to soft footwear and light walking within a few days. Follow-up visits will be scheduled to check healing. Full recovery usually takes 2–4 weeks depending on the procedure, but the relief is often immediate.

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FAQS

  1. What is an ingrown toenail?
    An ingrown toenail occurs when the nail edge grows into the surrounding skin, causing pain, swelling, and sometimes infection.

  2. What causes ingrown toenails?
    Common causes include tight shoes, improper nail cutting, trauma, or inherited nail shape.

  3. What are the symptoms of an ingrown toenail?
    Pain, redness, swelling at the nail edge, and sometimes pus or drainage if infected.

  4. When should I see a podiatrist for an ingrown toenail?
    If you have persistent pain, signs of infection, or repeated ingrown nails, see a podiatrist for assessment.

  5. How is an ingrown toenail treated?
    Mild cases may need nail trimming and footwear advice; severe cases may require minor surgical removal of part of the nail.

  6. Is ingrown toenail surgery painful?
    The procedure is done under local anaesthetic and is typically painless, though mild soreness may follow.

  7. How long does it take to recover from ingrown toenail surgery?
    Most patients return to normal activities in 2–3 days; full healing takes 2–4 weeks.

  8. Can ingrown toenails come back after treatment?
    If the nail edge is permanently removed (partial nail avulsion with phenol), recurrence rates are low (~5–10%).

  9. What is a partial nail avulsion?
    A minor procedure where a small nail strip is removed under local anaesthetic to relieve pressure.

  10. What is phenolisation?
    Application of phenol to the nail bed during surgery to prevent regrowth of the removed nail portion.

  11. Do I need antibiotics for an ingrown toenail?
    Not always; antibiotics are only needed if there’s an active infection, often combined with surgical treatment.

  12. Can I walk after ingrown toenail surgery?
    Yes, you can walk carefully, but it’s best to rest and elevate the foot for 24–48 hours.

  13. How should I care for my toe after surgery?
    Keep the dressing clean and dry, follow the podiatrist’s instructions, and return for follow-up if advised.

  14. Can ingrown toenails be prevented?
    Yes, by cutting nails straight across, wearing well-fitted shoes, and avoiding trauma to the toenails.

  15. Is ingrown toenail surgery covered by Medicare or insurance?
    Partial nail avulsion is often rebateable; check with your clinic and private health fund.

  16. Can children have ingrown toenail surgery?
    Yes, it’s safe for children when needed, usually under local anaesthetic.

  17. How long does ingrown toenail surgery take?
    The procedure usually takes 20–30 minutes.

  18. What shoes should I wear after ingrown toenail treatment?
    Open-toed sandals or loose-fitting shoes are recommended for the first few days.

  19. Can diabetic patients have ingrown toenail surgery?
    Yes, but it requires careful management to reduce infection risk.

  20. Why choose a podiatric surgeon for ingrown toenail treatment?
    They have specialised training to perform effective, low-recurrence procedures with expert care.

How do I book an appointment?

Appointments can be made online through the clinic’s booking portal or by calling directly. Visit the Contact Page or Book Online here