Ingrown toenail
Disclaimer
These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.
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Refer patient directly to the Emergency Department immediately if osteomyelitis is suspected.
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Introduction
Ingrown toenails are a relatively common condition and, in most cases, can be managed in primary practice.
Educating patients and families on prevention and non-invasive management is an important role of the General Practitioner.
Pre-referral investigations
- Physical assessment, taking particular note of factors impacting toenail growth.
- Medical history including factors impacting toenail growth including previous or recurrent toenail trauma, connective tissue disorders affecting toe.
Pre-referral management
- Provide education on prevention of ingrown toenails
- Cutting nails at appropriate length and straight across
- Well-fitting footwear to avoid pressure on the toenail
- Provide education on non-invasive treatments including soaking foot in warm saline followed by gently pushing skin away from nail.
- Treat infection as required.
- Consider referral to podiatrist or GP competent in surgical management of ingrown toenails under local anaesthetic if appropriate.
When to refer
The child should only be referred to General Surgery if:
- Recurrent ingrown toenails despite appropriate prevention and management techniques being trialled.
- Child unable to tolerate procedure under local anaesthetic due to age, disability or other factors.
How to refer
- Routine non-urgent referrals from a GP or a Consultant should go to the Central Referral Service
- Routine non-urgent referrals from a nurse practitioner, non-medical referrers or private hospitals go to the PCH Referral Office.
Essential information to include in your referral
- History of ingrown toenail – frequency, management, infections.
- Compliance with non-invasive ingrown toenail treatment and preventative techniques
- History of previous or recurrent trauma to the toe including previous nail bed injury, fracture or surgery.
- Any factors affecting normal toenail growth or healing (medical or behavioural factors).
- Any factors impacting inability to tolerate procedure under local anaesthetic (age, disability, fear of procedure).
- Patient demographics including parent contact details.
Useful resources
References
- HealthDirect. Ingrown toenails [Webpage]. Australia: HealthDirect; 2019 [updated August 2021; cited 2021 March]. Available from: https://www.healthdirect.gov.au/ingrown-toenails.
- Heidelbaugh J, Lee H. Management of the Ingrown Toenail. American Family Physician. 2009;79(4):303-8.
| Reviewer/Team: |
Dr Parshotam Gera (Head of Dept, General Surgery), Dr Liz Whan and Dr James Savundra (Head of Dept, Plastics)
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Last reviewed: |
Aug 2021 |
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Review date: |
Aug 2024 |
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