Ingrown Toenail, Nail Disorders & Treatments
If you have an ingrown toenail, call for an appointment today. Not taking care of the problem could lead to serious infections and other complications.
Depending on how severe the growth, we can perform conservative trimming or more aggressive nail removal. Whatever you do, do not perform your own surgery, which can lead to increased risk of infection.
This is a common condition for us. We can usually get you in the same day you call and get you back on your feet, pain-free in no time. Call for an appointment.
Early care is best for nail health. In their
protective role, nails bear the brunt of daily
activities. Walking, running, wearing shoes
or participating in sports are just a few of
the stresses and strains the feet must endure. |
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All or a portion of the nail plate can be damaged when the feet are
injured or abused. Nail problems are commonly caused by improper
trimming, minor injuries or repeated trauma. Some nail disorders can
also be congenital. Proper trimming (along the contour) on a regular
basis can help keep the toenails in the pink, as can wearing well-fitted,
low to moderately heeled shoes.
Ingrown Nail
Painful ingrown nails may be congenital, caused by an overcurvature
of the nail, or an imbalance between the width of the nail plate and
the nail bed. Toe injuries that change the nail’s contour also can lead
to an ingrown toenail. Toe deformities (such as a bunion that forces
the big toe to lean toward the second toe), high-heeled or narrow,
pointed shoes can put pressure between the nail and soft tissues,
eventually forcing the nail to grow into the skin.
Symptoms
Redness, swelling and infection make the toe very painful. Ingrown
nails can be accompanied by other toe disorders, such as excess
surrounding tissue or an outgrowth of bone beneath the nail.
Treatments for the Ingrown Nail
Surgery is often necessary to ease the pain and remove the offending
nail. Only a portion of the nail may be removed. If the entire nail is
affected or there is a severe nail deformity, the nail plate and matrix
(the cells that grow the nail) may be completely removed (see “Surgical
Treatments for Nail Disorders”).
Fungal Infections
Various types of fungi are present everywhere in the environment.
The dark, moist surroundings created by shoes and stockings make
the feet especially susceptible to fungal infection. Most fungi are
harmless until they penetrate the skin.
A fungus can invade through minor cuts, or after injury or repeated
irritation to the toes have caused the nail to separate from the bed.
Fungal infections of the nail plate and nail matrix are quite common.
Symptoms
Fungus may cause the nail to thicken and become yellow or brownish.
As the fungus grows, foul-smelling, moist debris can be seen. Pressure
from a thickened nail or the build-up of debris may make the toe painful.
Treatments for Fungal Infections
Treatment is best begun at the early stages of infection. The accumulation
of debris under the nail plate can lead to an ingrown nail, or to a more
serious bacterial infection that can spread beyond the foot. To reduce
pain associated with a thickened, infected nail, the surgeon may reduce
its thickness by filing the nail plate down with a surgical burr. Filing
will not, however, prevent the infection from spreading.
Oral and
topical medications may be prescribed when:
- Only a small portion of one nail is infected
- Several nails are affected
- Keeping the nail is desired
Medication may or may not completely eliminate the fungus. Often,
after medication is discontinued, the fungus recurs. Your podiatric foot
and ankle surgeon will monitor the results of oral prescriptions carefully
and will explain any possible side effects. While topical ointments usually
do not eliminate the fungus, they may be effective when used directly
on the nail bed, after the nail plate has been removed. Eliminating the
infection, in some cases, can only be achieved by permanent removal
of the nail plate (see “Surgical Treatments for Nail Disorders”).
Blood Beneath the Nail (hematoma)
A very common result of active lifestyles is blood, or a hematoma,
beneath the toenail. Hematomas are especially common among people
who jog or play tennis, caused by the toes repeatedly rubbing against
the shoe. A hematoma might indicate a fractured bone, especially after
an injury (such as dropping a heavy object on the end of the toe).
The toe should be examined by the podiatric foot and ankle surgeon,
who may take an X-ray to determine the most appropriate treatment.
Hematoma Treatments
If the hematoma is treated within the first few hours of forming, the
podiatric foot and ankle surgeon will create a tiny hole in the nail
plate using a fine-point drill or scalpel. This releases the blood and
relieves pain. If several days have passed and the blood clot becomes
painful, the nail plate may require removal so that the nail bed can
be cleaned. Some podiatric foot and ankle surgeons prefer to remove
the nail plate whenever blood forms beneath it, because the blood can
attract fungi and lead to infection. The nail may also be removed to
treat a bone fracture beneath the hematoma. If the bone has fractured
but has not moved out of its normal position, a splint may be used
to keep the toe aligned during healing. Nail plates that have been
removed will grow again within three to six months.
Surgical Treatments for Nail Disorders
If the problem is severe or chronic, surgery to remove all or a portion
of the nail may be recommended. Most surgeries are performed very
comfortably under local anesthesia and require less than one hour
at the podiatric foot and ankle surgeon’s office. Laser surgery, because
it requires special equipment, may be performed at a hospital. While
these are some of the most commonly prescribed treatments for nail
disorders, others may be used. The podiatric foot and ankle surgeon
will determine which treatment is likely to be the most successful
in each case.
Partial Nail Removal
For some cases of ingrown nails, only the portion of nail that is growing
into the skin is removed. If both sides of the nail are ingrown, they
may be removed during one procedure. After the affected portion of
nail (one-eighth to one-quarter inch) is taken, the nail bed is removed
along with any enlarged tissue adjacent to the nail plate. The nail
root and matrix are then destroyed by phenol, surgical removal or
laser heat (see “Permanent Nail Removal”). Finally, the skin may
be remodeled around the nail.
Permanent Nail Removal
Complete removal of the nail plate is a common remedy for
fungal infections and ingrown nails. During this procedure,
the nail plate is removed and the nail matrix is destroyed by
one of three methods:
- Phenol – an acidic chemical called phenol is applied only
to the nail matrix. This destroys the growth cells of the nail.
- Surgical removal – the nail matrix and bed is cut away.
Stitches are only occasionally necessary.
- Laser – a form of burning in which laser heat is focused
on the matrix cells.
Removal of Bone Overgrowth
Bone directly beneath the nail plate may become enlarged, developing
a spur or outgrowth that can deform the nail plate or lead to an
ingrown nail. Removal of excess bone may be performed concurrently
with surgery to partially or permanently remove the nail plate.
Care After Surgery
Most people experience very little pain immediately following nail
surgery and during the healing process, which lasts approximately
two to three weeks. If bone has been removed during surgery, a
longer healing process should be anticipated.
Total Nail Removal /Partial Nail Removal
The podiatric foot and ankle surgeon may prescribe medication for
pain and may, but not always, advise that the toe be soaked two or
three times daily for one week. Some amount of drainage is normal
when the nail has been removed chemically or by laser. If the nail
has been partially removed and stitches were used to form a new
nail fold, they are removed in approximately 10 days.
Ingrown Nail
Daily soaking in a saline solution may be recommended. If the toe is
inflamed or infected, a topical antibiotic is applied for three to seven
days; if the infection is severe, an oral antibiotic may be prescribed.
In very few cases, the infection may invade the bone beneath the nail,
requiring hospitalization and further treatment. The healing process
generally does not interfere with daily activities.
Hematoma
Following simple drainage of a hematoma, the podiatric foot
and ankle surgeon may advise that the toe be soaked and treated
with topical antibiotics.
How Will the Toe Look After Surgery?
After surgery to permanently remove the nail plate, the body
generates a hardened skin covering over the sensitive nail bed.
When this covering has developed, normal activities can be
resumed. Women can also use nail polish on this area.
Will the Nail Regrow After Removal?
Partial growth of the nail plate after permanent removal is rare,
but possible. Because the nail matrix has been destroyed, the
nail should not grow again.
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