Toenails Are One of the Most Common
Medical Problems That Affect the Human Body
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.
of Ingrown Nails
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.
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).
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.
for Ingrown Nails
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.
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.
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
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’!
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.
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.
of Ingrown Nails
After a Chemical Matrisectomy
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%.
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.
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!
should live the pain and agony associated with ingrown toenails. A simple, relatively
painless procedure is available to effectively treat and prevent recurrent ingrown
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.