• Ingrown Toenails

    Is it infected?

    Ingrowing toenails are very painful and can occur on any nail, but most often it is the hallux or great toenail that is involved. It is important to note that if left untreated the infection along the side of the nail will enter into the bone and cause a condition called osteomylitis. Bone infection may require long term antibiotics or even in severe cases amputation.  Diabetics with limited sensation in there feet, often lose a limb to an untreated ingrown toenail.  Nevertheless, the majority of patients with ingrown nails are easily treated and first present with pain along the side of the nail.

    There are a variety of conditions that may cause an ingrown nail to form but by far the most common is a genetic tendency.  The shape of the nail is directly related to the shape of the underlying bone.  If your parents and grandparents had a proclivity to forming ingrown nails than the likelihood is that their children will also have similar problems.  Another very common cause of this condition is injury.  The great toe is often stubbed or injured which can lead to the formation of a small bony growth under the nail; this in turn causes a curvature to the nail leading to ingrown nails. Tight shoes or stockings, that maintain a constant pressure on the nails, may over time push the sides of the nail into the skin.

    Treatments:

    If your nails are curved in and are not painful LEAVE THEM ALONE.  A true ingrown nail is very tender.  Over the years I have seen nails that appeared almost normal but were excessively tender to touch and when I surgical removed the ingrown section I was amazed at how deeply they were embedded into the skin.  Trimming the side of the nail may alleviate the problem, soaking in warm water, that has a splash of vinegar or some Epsom salt, may help ease the pain. Avoid over the counter remedies such as outgrow which is acid and eats away at the nail and the skin, this is rarely a cure and may even add to the infection. Nevertheless, a true ingrown nail can not be corrected via bathroom surgery and if left untreated the side of the nail becomes red and swollen and infected. Overtime, the nail itself will become deformed in appearance. Antibiotics alone may help reduce the infection but will not cure the problem.  A small section of nail needs to be excised.   DO NOT have the entire nail removed, this does not eliminate future ingrown nails and when the nail returns it is often ingrown again, as well as thick, discolored, crumbly and quite ugly.  A podiatrist is the only specialist that has the expertise and equipment needed to correct this problem.  I have personally treated thousands of nails and on an average day remove several ingrown nails permanently.

    Partial Matrixectomy:

    What makes our nail surgery unique are several specific factors.  Firstly, when a section of nail is being removed the toe needs to be anesthetized via a toe block.  We use a cold spray called Ethyl Chloride to freeze the skin so the initial stick of the needle is minimal; we then use a 30 gauge needle to introduce the numbing agent.  The needle itself is so thin that it can only be used with a few injectables.  This procedure is done slowly and precisely reducing the pain to a slight pressure.  Secondly, once the toe is asleep a very small section of the nail is removed, just enough to correct the problem without causing the nail to look deformed.  Unfortunately, if the problem has been chronic or has had previous surgery, a larger section of nail must be removed.  Most often the nail will look completely normal when it has healed; of course this depends on the initial level of infection and deformity.   Lastly, we use a combination of a radiowave surgitron and chemical cautery to destroy the nail matrix cells at the root to insure the least amount of regrowth.  Overall, we see a very small percent of recurrence with this procedure and very few complications.  For detailed post operative instructions see section on Office Forms.