Ingrown Nail Treatment in Ankara, Turkey

Ingrown nail treatment is a procedure aimed at relieving the pain, swelling, and inflammation caused by the nail embedding into the surrounding soft tissue. The treatment approach varies according to the stage of the condition; conservative methods are preferred in the early period, while surgical intervention is preferred in advanced cases.

In the treatment of chronic ingrown nails, infection control and reshaping of the nail edge are prioritized. Tissue healing is supported with topical antibiotics, antiseptic baths, and tampon applications that reduce pressure. Proper shoe selection and nail-cutting technique are important in preventing recurrence.

In surgical ingrown nail treatment, the ingrown part of the nail or the entire nail is partially removed under local anesthesia. Regrowth of the nail can be prevented with phenol or similar chemical agents applied to the matrix. This method provides a permanent solution, especially in frequently recurring cases.

The care process after ingrown nail treatment is critically important in reducing the risk of infection and accelerating healing. Daily dressing changes, maintaining a sterile environment, and avoiding pressure increase treatment success. Follow-up by a dermatologist or surgeon is recommended when necessary.

What Is an Ingrown Nail?

An ingrown nail is a common nail problem characterized by pain, redness, and inflammation, caused by the edge of the nail growing toward the surrounding soft tissue and embedding into the skin. It is most commonly seen on the big toe. Incorrect nail cutting, tight shoes, and abnormalities in nail structure are among the main causes. Treatment is carried out with medication if there is infection and surgical intervention in advanced cases.

What causes an ingrown nail?

Ingrown nails are a very common health problem in society and make up a significant portion of foot-related complaints. Many factors play a role in the development of this condition.

The most common causes of ingrown nails are:

• Cutting the nails incorrectly
• Rounding the nail corners
• Cutting the nails too short, from the base
• Narrow and pointed shoes
• Shoes that constantly squeeze the foot
• High-heeled shoes
• Genetic predisposition (curved nail structure)
• Excessive sweating of the feet (Hyperhidrosis)
• Intervening in the ingrown nail by oneself
• Blows to the nail (trauma)

Ingrown nails can actually be seen at any age, but in some groups they have almost become a “signature” condition. They are especially much more common in young people and adolescents between the ages of 10 and 30. Interestingly, they are seen almost twice as often in males in this age group compared to females. Anatomically, the overwhelming majority of ingrown nails, approximately 80% of cases, occur on the big toe (hallux) and usually on the outer (lateral) edge of the nail.

What are the stages of an ingrown nail?

An ingrown nail does not happen all at once; it progresses step by step. Knowing these stages is very important when planning treatment, because the treatment for each stage is different. Clinically, ingrown nails are divided into three stages.

Stage 1 (Mild Ingrown Nail)

This is the initial stage. There is no serious problem yet, but the warning bells have started ringing. The symptoms at this stage are:

• Mild redness at the edge of the nail
• Mild swelling (edema)
• Pain felt when touched or when wearing shoes
• (There is not yet any purulent discharge or “proud flesh”)

Stage 2 (Moderate Ingrown Nail)

The condition has progressed and infection has begun. The body is now giving a stronger response to this ingrowth. Its symptoms are:

• Increase in pain and it becoming constant
• Redness and swelling becoming very pronounced
• Onset of infection
• Purulent yellow-white discharge from the nail edge (purulent exudate)

Stage 3 (Severe Ingrown Nail)

This is the most advanced stage. There is now chronic inflammation and tissue reaction. Its symptoms are:

• Chronic and severe, unbearable pain
• Continuous purulent discharge
• Red, soft tissue that bleeds easily (“Proud flesh” – granulation tissue)

The treatment strategy is also determined according to these stages. While protective and non-surgical methods are at the forefront in Stage 1, a permanent and surgical solution (matricectomy) is generally required in Stage 2 and Stage 3. Recurrence of ingrown nails even after successful surgical treatment is an important problem. Most of these recurrences result from the continuation of underlying behavioral risk factors (incorrect nail cutting, inappropriate shoe selection). Therefore, regardless of the stage, an integral part of treatment is providing the patient with detailed education on proper nail care and preventive measures.

Are there non-surgical methods for early-stage ingrown nails?

Yes, especially when we catch an ingrown nail at Stage 1, our goal is to correct the direction of the nail without the need for surgery. These protective and mechanical methods aim to reduce the pressure the nail exerts on the skin and redirect the nail toward the correct growth direction.

The main non-surgical ingrown nail methods used in Stage 1 or mild Stage 2 are:

• Placing packing material under the nail (Packing)
• Gutter splinting
• Nail wire application (Orthonyxia)
• Taping technique (Taping)
• Comfort care (Warm water baths)

Placing packing material under the nail is based on the principle of separating the nail from the skin and holding it up like a lever by placing a small piece of cotton or waxed dental floss under the ingrown edge of the nail. For hygiene, this packing should be changed every day.

The taping technique, on the other hand, is a low-cost and very effective first-line treatment. Using a special surgical tape (plaster), the skin fold on the side where the nail is ingrown is pulled away from the nail and attached tightly to the finger. This immediately reduces the pressure between the nail and the skin and provides very rapid pain relief (usually within one week). Patients are asked to continue this taping by changing it daily, usually for 4 to 8 weeks, until the nail edge is fully exposed.

Gutter splinting and nail wire (Orthonyxia) are more professional clinical applications. In the “gutter splinting” method, a small, sterile plastic tube (gutter) is placed on the ingrown nail edge; this tube acts as a shield between the nail and the skin. In the “nail wire” application, special wires are attached or fitted onto the nail. These wires correct the ingrowth by mechanically changing the curvature of the nail and lifting its edges upward.

In addition to these, comfort care is also important. Soaking the affected foot several times a day for 10-20 minutes in warm soapy water or water with Epsom salt (magnesium sulfate) softens the soft tissue around the nail, cleans the area, and provides relief.

What are the challenges of non-surgical ingrown nail treatments?

Although these methods sound very appealing, their greatest challenge is time and patient compliance.

Taping, wire, or packing treatment can relieve pain quickly, but this does not mean the problem has been solved. It takes a very long time for the nail to structurally correct itself and for the ingrown condition to heal “completely.” Research shows that the average time required for complete structural correction with these methods is approximately 21 weeks (that is, 5-6 months).

This long process requires the patient to carry out this care every day without interruption. If the patient cannot comply with these long-term daily care protocols (compliance failure), the treatment is discontinued halfway and the ingrown nail inevitably recurs.

For this reason, especially in athletes, soldiers, or people who spend long hours in shoes due to their work and need a fast, definite solution, or in patients who have difficulty complying with long-term care, rather than waiting through this long and laborious process, it may be a more preferable strategy to proceed directly to a permanent surgical solution (matricectomy) if it is a Stage 2 ingrown nail. The aim here is to minimize the patient’s loss of productivity and eliminate the risk of recurrence due to noncompliance.

What is the permanent solution for advanced ingrown nails?

If the ingrown nail has reached Stage 2 (infected) or Stage 3 (with proud flesh), protective methods are no longer sufficient. At this stage, our goal is not only to relieve the problem temporarily but to solve it permanently in a way that will prevent recurrence.

Although it is generally known among the public as “nail removal,” this is an incomplete and often incorrect definition. If only the ingrown part of the nail (or worse, the entire nail) is removed, the underlying nail root (matrix) remains intact, so the nail will grow back. And most likely, it will grow back in the same ingrown manner. Therefore, removing only the nail is not a permanent solution; it only postpones the problem for a few months.

In advanced ingrown nails, the “gold standard” and permanent solution is the application of Chemical Matricectomy together with Partial Nail Avulsion (PNA).

This procedure consists of two stages:

• Partial Nail Avulsion (PNA): The entire nail is not removed. Only the small edge portion causing the problem, the ingrown section (usually a 2-3 mm strip), is freed with special instruments all the way to the root of the nail and removed.
• Chemical Matricectomy: This is the actual procedure that provides permanence. A special chemical substance (usually Phenol or Sodium Hydroxide) is applied to the area where the “nail root” cells (germinative matrix) producing that ingrown part of the nail are located, in order to permanently destroy these cells.

In this way, nail tissue can no longer grow from that area, and the ingrown problem is permanently resolved for that region. The remaining 90% healthy part of the nail continues to grow normally.

Are there risks before ingrown nail surgery (matricectomy)?

This procedure is an extremely safe, comfortable, and short intervention performed in a dermatology clinic or office under local anesthesia (numbing only the finger). However, as with every intervention, some conditions that may particularly affect wound healing must be carefully evaluated before the procedure.

The procedure begins with a “digital nerve block” (finger numbing) performed from the base of the finger. In this way, absolutely no pain is felt during the procedure.

The conditions that constitute a definite obstacle to chemical matricectomy (absolute contraindications) are:

• Moderate or severe vascular disease (Arterial insufficiency)
• A known allergy to the chemical agent used (e.g. Phenol)
• Other serious systemic factors that delay wound healing

Here, especially patients with Diabetes Mellitus require special attention. Not every patient with diabetes is unsuitable for this procedure. However, patients with diabetes-related vascular disorder (vascular complication) and a risk of delayed wound healing are in the high-risk group.

Why is this caution so important? Because chemical matricectomy actually creates a “controlled chemical burn” in the area. In order for this burn to heal properly, it is essential that there be sufficient and healthy blood flow to the area. If blood flow is insufficient in high-risk diabetic patients, this small and simple surgical intervention may turn into a chronic non-healing wound or serious infections. Therefore, the dermatology specialist must definitely evaluate peripheral vascular circulation before the procedure in high-risk individuals.

How is ingrown nail surgery (Phenol Matricectomy) performed?

Phenol matricectomy is the most commonly used surgical protocol for ingrown nails, proven in its success and accepted as the “gold standard.” The procedure is performed meticulously to effectively destroy the nail root cells and avoid damaging the surrounding healthy tissue.

A Phenol Matricectomy procedure progresses step by step as follows:

• Anesthesia and Isolation
• Partial Nail Avulsion (PNA)
• Matrix Ablation (Destruction of the Root)
• Neutralization and Dressing

First, the finger is completely numbed with a digital block, and the patient feels nothing during the procedure. Then, a “tourniquet” (tight rubber band) is applied to the base of the finger to temporarily stop blood flow. This is very important; because it both provides a bloodless, clean surgical field and prevents the chemical substance to be used shortly from becoming ineffective (neutralized) by mixing with blood or body fluids. A dry field is critical for the success of the chemical.

In the second step, that is, Partial Nail Avulsion, an approximately 2-3 mm strip is cut longitudinally from only the ingrown edge of the nail all the way to the root of the nail with a special nail cutter. This cut piece of nail is firmly grasped with a surgical instrument (hemostat) and gently removed from the underlying nail bed with a rotating motion.

The third and most critical stage is Matrix Ablation, that is, destruction of the root. After the nail piece is removed, the sulcus where the root cells (germinative matrix) producing that nail are located must be carefully dried. Liquefied Phenol BP is used by soaking it into small cotton-tipped applicators. This chemical is carefully applied only to the area where the nail root is located. Great care is taken not to cause unnecessary damage to the surrounding tissue.

In the final step, immediately after the chemical application is completed, the area is washed with a solution containing alcohol and chlorhexidine to neutralize the remaining phenol (stop its effect). The tourniquet is removed, and blood flow returns to the finger. Bleeding, which is usually minimal, is controlled. Finally, the procedure is completed by applying povidone-iodine (such as Betadine) antiseptic ointment, a non-adherent antiseptic gauze, and a bandage to the area.

Are there options other than Phenol in ingrown nail treatment?

Yes, although phenol is the most common and reliable agent, it is not the only option used to destroy the nail root.

• Sodium Hydroxide (NaOH): Another strong chemical agent used to destroy the nail root. Its recurrence results are similar to phenol and it is an effective alternative.
• Surgical Excision (Winograd Procedure): This method is somewhat different. It is used especially in cases complicated by severe soft tissue growth (“proud flesh” or hypertrophy), such as in Stage 3. In this technique, not only the nail root but also the excess hypertrophic soft tissue that has grown over the nail is surgically cut out and removed in a wedge shape.
• Physical Methods: These are methods in which the nail root is destroyed physically rather than chemically. These include cryosurgery (freezing), electrocautery (burning), or laser ablation. However, chemical matricectomy is generally preferred more often in terms of effectiveness and ease of application.

Which is better in ingrown nail treatment: Phenol or Sodium Hydroxide (NaOH)?

This is an important question for patients, and the answer depends on what is meant by “better.”

When we look at long-term studies, no statistically significant difference has been found between Phenol and NaOH in terms of recurrence rates. Both are similarly successful in permanently resolving ingrown nails.

However, the “better” part of the issue lies in the differences in the postoperative healing process (postoperative morbidity). These small nuances allow us to make a choice according to the patient’s priorities:

Use of Phenol:

• Healing Process: Phenol generally causes a slightly longer period of “discharge” (exudation or leakage) compared to Sodium Hydroxide. The average discharge period is around 14 days.
• Pain: This is where Phenol’s biggest advantage lies. The risk of developing “prolonged pain” after the procedure is very low (reported in only 1.8% of cases).

Use of Sodium Hydroxide (NaOH):

• Healing Process: NaOH is associated with a shorter discharge period. The average discharge period is around 11 days.
• Pain: In contrast, the rate of reporting “prolonged pain” after NaOH use is significantly higher than Phenol (approximately 12.9% of cases).

Clinical Result:

Since both methods are similarly effective in terms of recurrence, the choice can be made according to the patient’s sensitivity. If the priority for the patient is to minimize the risk of pain after the procedure, Phenol offers a very clear advantage. If the priority for the patient is a discharge period that is a few days shorter and returning to foot care more quickly, NaOH may provide a slight advantage.

Is care difficult after an ingrown nail operation?

No, the patient’s full compliance with the wound care regimen after matricectomy is critically important for rapid healing and prevention of secondary infection, but this care is generally quite simple.

After the procedure, there is usually a minimal need for painkillers. The first surgical dressing applied should be kept dry until the next day. Patients are generally called back to the clinic approximately three days after the procedure for the first dressing change and wound check.

After the first check-up, until the wound heals completely (this process generally takes 2 to 3 weeks), the patient is asked to apply some simple steps at home.

The daily care steps are:

• Cleaning the area with saline (physiological serum) after a shower
• Gently drying the area after cleaning
• Applying antiseptic ointment (such as Povidone-iodine, Betadine)

Covering the area with a clean adhesive bandage or a simple dressing

An important note here is that the development of secondary infection after the procedure is a known risk (around 10.5% in some studies). However, it has been proven that routinely giving protective (prophylactic) oral antibiotics before or after the procedure to reduce this risk does not improve outcomes or reduce the risk of infection. Therefore, unless an active infection develops, routine antibiotic use is not recommended for ingrown nail intervention. Similarly, adjunct dressing materials such as hydrogel, paraffin gauze, or some special antibiotic preparations have not been shown to reduce postoperative infection risk or shorten healing time. Simple, clean, and antiseptic care is sufficient.

What should be done to prevent ingrown nails from recurring?

The permanence of ingrown nail treatment depends not only on a successful surgical intervention but also on eliminating the underlying causes. As with non-surgical methods, an important part of recurrences after surgery also results from ongoing behavioral risk factors.

Therefore, long-term preventive education is essential to ensure that ingrown nails never recur again.

The two most important rules for permanently preventing ingrown nails are:

• Cutting the nails straight across
• Never rounding the nail corners
• Not cutting the nails too short (enough to grow into the skin)
• Wearing comfortable, wide-toed shoes (with a wide toe box)
• Avoiding narrow, pointed, or tight shoes that continuously apply pressure to the toes

Planning follow-up visits at regular intervals such as every 6 months to monitor the treated area in terms of regrowth or recurrence and to reinforce these preventive education principles is a good method to guarantee long-term success.