Conditions of the Foot
by Dr. Mark H. Tompkins

Ingrown and/or Infected (Ingrown) Toenails and
How I Treat This Condition Day-to-Day in My Practice

No one is immune…from pediatrics (kids) to geriatrics (seniors); ingrown nails are almost as common as headaches for some people. Heredity plays an important role in the incidence of ingrown nails. Ingrown nails can be exacerbated by wearing improper shoes, or the improper cutting of nails; but they are predominantly caused by inherited anatomical considerations.

The ‘typical’ ingrown nail begins with some minor soreness on either the inside border (towards the other foot) or the outside border (away from the other foot) of any toe. The most common toe affected is the big toe or hallux.

Diagnosis of Ingrown Nails

The best way to self-diagnose whether you have an ingrown nail or not, is to push, with slight pressure, on both sides of any toenail. You should be able to do this without eliciting any discomfort. If you feel any pain, that nail border is ingrown, or becoming ingrown. You should be able to apply a significant amount a pressure to any/all nail borders (of all your toes) without eliciting any discomfort or pain. Again, if there is any discomfort, YOU HAVE AN INGROWN NAIL.

(Patients with diabetes and any secondary nerve and/or circulatory problems, MUST BE extremely cautious using pain or discomfort as an indicator of whether they have an ingrown nail. Periodic, Podiatric, professional evaluation and treatment is MANDADORY for any person with diabetes).

Depending upon how severe the ingrown nail is, it will slowly become worse, causing more pain with less pressure, and will become infected if not treated properly. Some ingrown nails progress to becoming infected very quickly and some may take months. But rest assured, if you are not able to simply remove the offending border completely, the corner of your toe will become infected sooner or later.

Treatment for Ingrown Nails

The first inclination people have when they notice a minor ingrown nail is to begin to perform varying levels, of what I refer to as, bathroom surgery. That is, attempting to remove the offending border, or corner of the nail that is bothering them with various home remedies and/or treatments. If you can simply remove the edge of the corner with a nail clipper, more than likely, this will eliminate the discomfort and may provide relief for a varying amount of time. However, the nail will continue to cause problems as the nail plate grows-out.

The best way to treat an ingrown nail is to seek treatment from an experienced medical professional. Podiatrists treat the vast majority of ingrown toenails, and are able to do so with the least amount of pain involved, and, with the best results. Self-treatment of ingrown nails, almost always results in the toe becoming infected. If there is swelling, redness, and/or drainage that are developing along the side of your ingrown nail and/or toe….IT IS BECOMING INFECTED. The longer you wait, the more infected the toe (nail) will become. Soaking in Epsom® salt, using antibiotic ointment, or OTC ingrown nail medications, such as Outgrow®, may provide some temporary relief of your symptoms; however, the nail will continue to cause problems until the offending nail border is completely removed appropriately by a medical specialist.

The successful treatment of ingrown nails is dependent upon early diagnosis and treatment. The earlier an ingrown nail is treated, the better chance it will not reoccur again.

In my office, I typically anesthetize the entire toe when treating an ingrown nail. I utilize a local anesthetic mix (Xylocaine® and Marcaine®) and ethyl chloride -a cold numbing spray applied to the injection site(s). The Xylocaine® provides immediate anesthesia (numbness) and the Marcaine® allows for extended anesthesia for up to 8 hours. I utilize an ‘H-block’ technique. Although this technique requires three individual injection sites at the base of the toe (far removed for the painful ingrown nail!!), it allows for complete anesthesia (no feeling) of the toe involved. Once the toe is anesthetized, there is absolutely NO PAIN involved with performing the actual ingrown nail procedure. This entire process takes just seconds, with minimal discomfort….and most patients wished they had come-in earlier to have their ingrown nail ‘fixed’!

Once the toe becomes completely anesthetized, the toe is disinfected, and the offending ingrown nail border is removed utilizing an aseptic technique. A chemical agent (89% phenol) is then applied (usually 3-30 second applications) to the nail root (matrix) to cauterize the epidermal cells that are responsible for growing the abnormal section of nail. This chemical matrisectomy is the most common procedure performed in the successful treatment of ingrown toenails.

After care is minimal, and limited to Epsom® salts (or simple table salt) soaks, and the application of an OTC antibiotic ointment/cream, and a bandaid for a few days. A larger compressive bandage is initially applied that prevents ANY BLEEDING, and can be worn with most practical shoes. Patients may return to work or school, but I encourage them to stay-off their foot (with their shoe off) as much as possible the first evening. Most patients have minimal pain the first evening and take only OTC anti-inflammatory medication, such as Tylenol®. Normal activities may be resumed the next day. I give patients a prn (as needed) follow-up appointment within 2 weeks, but the majority of patients need not return to the office.

Reoccurrence of Ingrown Nails After a Chemical Matrisectomy

The possibility of the ingrown nail growing back and causing recurrent problems varies, but again, early treatment of non-complicated, and non-infected, ingrown nails, renders success rates in the vicinity of 80-90%.

If the nail border/toe has become infected, reoccurrence rates can fall to below 50%. If the toe (nail) has been infected for a number of weeks (or months) prior to seeking treatment, there is usually a significant amount of redness, swelling, and drainage that has occurred. This in-turn, changes the temperature and ph of the surrounding tissues, limiting the effectiveness of the phenol to cauterize the nail root (matrix) sufficiently to prevent reoccurrence.

If the toe has been infected for multiple weeks, pain is not a good barometer to use, to determine if professional treatment is necessary. Many times the toe becomes less sensitive as the infection progresses and the nerve endings desensitize. Again….THE MOST IMPORTANT FACTOR IN SUCCESSFULLY TREATING INGROWN TOENAILS, IS EARLY INTERVENTION AND TREATMENT!

No one should live the pain and agony associated with ingrown toenails. A simple, relatively painless procedure is available to effectively treat and prevent recurrent ingrown toenails.

So forget about that terrible experience you may have had at one of those ‘Doc in the Box’ clinics, or by a non-foot specialist, and make an appointment today with a qualified, experienced Podiatrist (preferably, board certified by the American College of Foot and Ankle Surgeons) to get that terrible ingrown toenail treated once and for all.




Athletes Foot

Bio-Mechanical Pain


Calluses & Corns

Diabetic Foot

Flat Feet

Hallux Limitus/Rigidus

Hammer Toes

Heel Pain/Heel Spur

Ingrown Nails


Morton's Neuroma



Plantar Fasciitis

Plantar Warts

Running Injuries

Sclerosing Injection Treatments


Severs Disease

Shin Splints

Sweaty Feet/Odor

Toenail Fungus





I M P O R T A N T  C O P Y R I G H T   I N F O R M A T I ON

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Dr. Mark Tompkins | 4402 Vance Jackson, Suite #146 | Phone: 210-341-2202

Copyright © 2001-2009 Dr. Mark H. Tompkins.  All rights reserved.