How to treat an ingrown toenail located near the nail base?

Treatment of Ingrown Toenail Near the Nail Base

For an ingrown toenail located near the nail base, the recommended treatment is to begin with conservative measures including warm soaks with antiseptic solution, placing cotton wisps under the nail edge, and proper nail trimming, reserving partial nail avulsion with phenolization for cases that don't respond to conservative management. 1

Assessment of Severity

• Determine severity of the ingrown toenail:
  • Mild: nail edge causing discomfort with minimal erythema
  • Moderate: pain, erythema, edema, and possible drainage
  • Severe: significant pain, pronounced inflammation, infection with purulent drainage, or granulation tissue

Conservative Management (First-Line Treatment)

For mild to moderate ingrown toenails near the nail base:

1. Warm soaks with antiseptic solution

   • Soak the foot in warm, soapy water for 10-15 minutes, 2-3 times daily 1
   • Consider adding dilute vinegar (50:50 dilution) for antimicrobial effect 1

2. Separation techniques

   • Place cotton wisps or dental floss under the ingrown nail edge to separate it from the nail fold 1, 2
   • This helps relieve pressure and promote healing

3. Topical treatments

   • Apply mid- to high-potency topical corticosteroid ointment to reduce inflammation 1
   • Consider topical antiseptics to prevent infection

4. Gutter splint application

   • Apply a gutter splint to the ingrown nail edge to separate it from the lateral fold, providing immediate pain relief 3

Surgical Management (For Moderate to Severe Cases)

When conservative measures fail or for moderate to severe cases:

1. Partial nail avulsion

   • Remove the detached or ingrown portion of the nail plate near the base
   • Clean the nail bed thoroughly 1

2. Matrixectomy options

   • Chemical matrixectomy with phenol is the preferred method for preventing recurrence 1, 4
   • Partial nail avulsion combined with phenolization is more effective than surgical excision alone 2

3. Alternative techniques for nail base ingrown toenails

   • Radiofrequency ablation
   • Carbon dioxide laser ablation
   • Electrocautery of the nail matrix 1, 4

Special Considerations for Nail Base Ingrown Toenails

• The nail base location requires careful attention to avoid damage to the nail matrix
• Surgical drainage is mandatory if an abscess has formed 1
• For diabetic patients, more vigilant monitoring and earlier intervention are required due to increased infection risk 1

Prevention and Follow-Up

• Proper nail care: trim nails straight across, not curved 1, 5
• Wear shoes with adequate toe box width 1
• Avoid high heels and pointed shoes 1
• Regular follow-up every 2-4 weeks until resolution 1
• Return immediately if signs of infection develop 1

Complications to Monitor

• Permanent nail deformity
• Secondary infection
• Permanent onycholysis
• In rare cases, severe infections can lead to serious complications 1

The location of the ingrown toenail near the nail base makes proper treatment particularly important to prevent damage to the nail matrix and potential long-term nail deformity. Starting with conservative measures and progressing to surgical intervention when necessary provides the best approach for resolving the condition while minimizing complications.