Ingrown Toenail Surgery in Belgrade — a Permanent Solution Without Pain

What is an ingrown toenail?

An ingrown toenail (medically: unguis incarnatus) is a condition in which the edge of the nail grows into the surrounding skin (the nail fold), causing pain, redness, swelling and not infrequently pus. It most often affects the big toe, though it can appear on other toes too. In the early phase the problem is mild, but if it is not resolved, the skin around the nail becomes inflamed, proud flesh (granulation) forms and an infection that keeps recurring develops.

An ingrown toenail is most often caused by improper cutting of the nails — too rounded or too short — tight and narrow footwear, toe injuries, excessive sweating, but also a hereditary form of nail that is too curved (rolled). In some people the anatomy of the nail and nail fold simply favors ingrowth, so the problem returns despite tidy care.

Although it seems like a trifle, an ingrown toenail significantly interferes with everyday life — it makes walking, wearing footwear and sleeping difficult, and in people with diabetes or poorer circulation it also carries an additional risk of more serious infection. That is why it should not be neglected or dealt with by home removal, which most often only worsens the inflammation.

At Medical Time the ingrown toenail is resolved expertly and permanently. The goal is not only to relieve the current symptom, but, where needed, to prevent the problem from ever recurring — with a safe surgical technique, in sterile conditions and with minimal discomfort for the patient.

When is ingrown toenail surgery indicated?

A milder, early ingrown toenail can sometimes be calmed with conservative measures. However, when the inflammation is pronounced, when pus appears or the problem keeps recurring, a surgical solution is the surest and most lasting path to a cure. The decision is made by the surgeon after examining the toe.

Ingrown toenail surgery is recommended in the following situations:

• severe pain when walking, on touch or wearing footwear that does not go away
• pronounced redness, swelling and warmth of the skin around the nail (signs of inflammation)
• pus and discharge leaking from the nail fold
• the formation of proud flesh (granulation tissue) at the edge of the nail
• an ingrown toenail that keeps coming back despite tidy care
• bilateral or multiple ingrowth of the nail edges
• an ingrown toenail in people with diabetes or poorer circulation, where the risk of complications is higher

How ingrown toenail surgery is performed

The goal of surgery is to remove the part of the nail that grows in and the inflammation it causes, while preserving the healthy part of the nail and a tidy appearance of the toe. Most often the whole nail is not removed, but only the ingrown, lateral strip — which is less traumatic for the patient and allows a faster recovery.

A partial excision (partial avulsion) means that the surgeon, under local anesthesia, removes a narrow lateral strip of the ingrown part of the nail together with the inflamed tissue and, if needed, the proud flesh. This immediately relieves the pressure on the nail fold and calms the inflammation.

For ingrown toenails that recur or are pronounced, phenolization is used — a chemical treatment of the root (matrix) of that narrow part of the nail with phenol. This technique permanently prevents the lateral part of the nail from growing back and ingrowing, resolving the problem once and for all, with a very low percentage of recurrence. The nail itself still grows, only slightly narrower, so the aesthetic result is as a rule very good.

Which technique is best for a specific case is assessed by the surgeon depending on how far the nail has ingrown, whether the problem recurs and what state the surrounding skin is in. In more severe cases a wider correction of the nail fold is also possible.

Preparation for the procedure

Preparation for ingrown toenail surgery is simple. The procedure is done on an outpatient basis, under local anesthesia, so fasting or special preparation is most often not needed. Everything begins with an examination by the surgeon, who assesses the degree of ingrowth, the presence of infection and the best technique for a permanent solution.

If the toe is heavily inflamed and pus-filled, local therapy is sometimes applied briefly first to partly calm the inflammation before the procedure itself. The surgeon decides on this at the examination.

What is important to inform the surgeon of and what to keep in mind:

• medications you take, especially blood thinners
• diabetes, circulatory diseases and a tendency to impaired wound healing
• allergies, especially to local anesthetics and medications
• on the day of the procedure bring comfortable, wider footwear or slippers (open footwear if possible)
• plan to avoid longer walking and straining the foot after the procedure
• bring earlier findings if you have already treated an ingrown toenail

The procedure, anesthesia and duration

At the start of the procedure the toe is disinfected, and then local anesthesia is given at the root of the toe (a block), which fully numbs the toe. Once the anesthesia starts to work, the patient feels no pain during the procedure — at most a slight pressure. The whole procedure is done in sterile conditions, with a dressing at the end.

The surgeon then removes the ingrown, lateral part of the nail together with the inflamed tissue. If phenolization is planned, the root of that part of the nail is treated with phenol to permanently prevent ingrowth from recurring. The wound is rinsed, dressed with a sterile bandage, and the toe is bandaged so it is protected and relieved.

The procedure itself most often takes between 20 and 40 minutes, depending on whether a partial removal or also phenolization is done, and on the degree of inflammation. With preparation and dressing, the stay at the facility is short, and the patient goes home the same day, as a rule on their own.

Immediately after the procedure the toe is dressed, and the patient receives clear instructions for home wound care and an appointment for the first dressing change. The anesthesia of the toe wears off within a few hours, so it is recommended that during that period longer standing and walking are avoided.

Recovery and care after the procedure

Recovery after ingrown toenail surgery is, as a rule, quick. As early as the next day most patients can walk and perform lighter activities, wearing footwear that does not press on the toe. Mild tenderness and swelling are normal in the first days and gradually subside. The key to a good outcome is tidy wound care and regular dressing changes.

The wound should be kept clean and dry, and dressing changes are done according to the surgeon's instructions, until the skin has fully healed — which usually takes from two to several weeks, depending on the technique and the degree of inflammation. During this period comfortable, wider footwear is worn, and long walking, running and sport are avoided.

What is recommended during recovery:

• keep the wound clean and dry and dress it according to the instructions
• wear comfortable, wider footwear that does not press on the toe
• keep the foot elevated whenever you can in the first days to reduce swelling
• avoid longer walking, running, sport and bathing in the pool and the sea until the wound has healed
• come to the agreed dressing changes and follow-ups
• contact the doctor if increased pain, pus, spreading redness or a temperature appear

Risks and possible complications

Ingrown toenail surgery is a safe and routine procedure, and serious complications are rare. Most common are transient and mild occurrences in the wound area that subside with regular care. Still, as with any procedure, it is important to know the possible occurrences.

Minor bleeding, transient pain and swelling are possible, as well as a wound infection that is treated with local therapy and, if needed, antibiotics. In some patients the wound heals somewhat more slowly, especially if there is diabetes or poorer circulation. If a permanent solution (phenolization) is not done, there is a possibility that the ingrown toenail reappears over time.

After phenolization the lateral part of the nail becomes permanently somewhat narrower, which is the goal of the procedure and as a rule is aesthetically unnoticeable. With a proper technique, sterile conditions and following the care instructions, most risks are reduced to the lowest level. That is why it is important that the ingrown toenail is not dealt with at home, but expertly, in a facility that provides safe, sterile conditions.

Why have ingrown toenail surgery done at Medical Time

At Medical Time we resolve the ingrown toenail permanently and painlessly, with an experienced surgical team and the modern technique of phenolization that gives a very low percentage of recurrence. The procedure is done in sterile, hospital conditions, on an outpatient basis, and the patient goes home the same day.

We attach special importance to preserving a tidy appearance of the toe and to making the recovery as short as possible. After the procedure we remain at your disposal for dressing changes, follow-ups and all advice on care, until the toe has fully healed.

• a permanent solution with phenolization and a very low percentage of recurrence
• a painless procedure under local anesthesia, with a preserved appearance of the toe
• an experienced surgical team and sterile, hospital conditions
• an outpatient procedure and a return home the same day
• a special approach for patients with diabetes and poorer circulation
• clear care instructions and regular dressing changes until full healing
• quick booking, without long waiting

Price — ingrown toenail surgery

The price of ingrown toenail surgery depends on the technique applied (partial removal or phenolization), on whether it is done on one or both edges of the nail, as well as on the degree of inflammation. You get the exact price and an appointment quickly, by calling or through the contact form.

• Surgeon's examination and assessment of the ingrown toenail
• Partial removal of the ingrown part of the nail
• Ingrown toenail surgery with phenolization (permanent solution)

For an individual estimate and an appointment, call 062-399-888.

Frequently asked questions about ingrown toenails