What is an Ingrown Toenail?
Nails grow from special cells beneath the cuticle called the matrix. This growth center can vary in size and shape. It may produce a nail which is flat or curved, wide or narrow. Those people with curved or wide toenails are more prone to develop ingrowing of the nail where it becomes embedded in the adjacent skin fold. One of the most common causes of ingrown nails is heredity. Other causes may include improper trimming, trauma to the nail, temporarily having a toenail fall off, ill-fitting shoes, fungal infections, and rarely bone spurs under the nail which can deform the nail plate. It is generally recommended to trim your nails straight across. People get into trouble when they begin clipping down deeply into the nail corners. Frequently, they miss a small splinter of nail, called a spicule, which then grows out and the sharp point pierces the skin. This can serve as a portal of entry for bacterial infection.
Ingrown nails may cause pain at the end of the toe or along one or both edges. Pain is usually worse with shoe pressure. It is often accompanied by redness, mild swelling, bleeding, and sometimes purulent drainage if infection is present.
Home remedies such as soaking in warm water diluted with Epsom salts, betadine, or vinegar can sometimes help. Applying a small amount of antibiotic ointment to the corner of the affected nail daily may soften it and lessen bacteria present there. If the above measures fail you will likely need to see a podiatrist. Cutting a V notch in the middle of the nail or tucking cotton under the edge are rarely effective and can sometimes aggravate the problem.
Our initial treatment has the goal of relieving pain & clearing infection or inflammation. If the toe is not infected, we may be able to carefully trim the ingrown nail edge and remove the spicule if present with minimal discomfort.
An infected toenail or deeply embedded spicule usually requires temporarily removing the edge or in some cases the entire nail if the infection is extensive. Local anesthetic is typically used to eliminate pain during the procedure. After nail removal, follow instructions for care, and if an antibiotic is prescribed, take it as directed. These measures should allow the toe to heal and for the infection to clear within a few days to a week. The nail will grow back within a few months, sometimes taking up to a year.
Long Term Treatment
If it continues to cause problems, it often becomes necessary to treat the root(matrix) so that the edge, or in some cases the entire nail is not allowed to grow out again. This permanent procedure, called a matrixectomy, usually must be done after an infection has cleared to prevent the spread of infection. These procedures are commonly done in our office with sterilized instruments and with local anesthesia to numb the toe. The type of procedure can vary.
The majority of the time a permanent nail removal is done by carefully applying a chemical such as phenol or sodium hydroxide to the root. This is called a chemical matrixectomy. About 95% effective, this procedure does not require stitches and usually results in only mild discomfort afterward. However, it may take several weeks or longer to completely heal. Most commonly only the edge or both edges of a nail are removed in this manner. If only a small sliver of nail is removed, it is often difficult to tell anything was done to the nail. The toenail will just be skinnier. If the nail is severely deformed, then complete removal is sometimes the best option.
A surgical matrixectomy involves cutting through the skin with a scalpel to remove(excise) the root. This is a highly effective procedure but is more painful than the chemical method. Stitches and an open toed shoe are used for 10-14 days. Today this type of procedure is only rarely done, usually if a previous chemical treatment has failed.
Many people don’t realize that there are effective procedures to eliminate the pain of troublesome ingrown nails and instead live with them for years or decades. Please give us a call to set up a consult so you can learn more about how we can help you. You don’t have to suffer from ingrown toenails!
Ingrown Toenails Podiatrist
Judd Davis, DPM with A New Step Foot & Ankle Clinics is a compassionate podiatrist (foot and ankle doctor) who helps patients with ingrown toenails, foot pain and other foot and ankle problems. A New Step Foot & Ankle Clinics is located in Colorado Springs, Colorado.