INGROWN TOENAILS

WHAT IS AN INGROWN TOENAIL?

When the medial (inside) or lateral (outside) edge of the nail plate irritates the adjacent skin or nail fold, it can

cause pain and inflammation. This is considered an ingrown toenail. In addition to pain, one may also notice

increasedswelling and/or redness of the surrounding skin. If there is purulent drainage (usually yellow or

green) or malodor, this isconsistent with an infected ingrown toenail (aka paronychia).

 

WHY DO INGROWN TOENAILS OCCUR?

It is still not known what exactly causes ingrown toenails; however, inmy experience, it often seems related to

trauma, improper trimming of the nail, and tight shoe gear. Genetics and certain medical conditions may also

increase the likelihood of developing an ingrown toenail (1).

 

TREATMENT OF INGROWN TOENAILS:

The treatment options for an ingrown toenail often depend on the severity of the condition and whether or not it is the first ingrown toenail you have experienced or a recurring one. 

 

Conservative Treatment Options:

If there is minimal pain and no signs of infection, at-home remedies, such as soaking the foot in warm, soapy water, or doing Epson salt soaks, may help soften the nail and give pain relief (1); however, this is usually only a temporary solution as it is not treating the underlying issue, which is the nail irritating the skin. If symptoms worsen, or there are signs of infection (i.e. increased redness,

swelling, pain, and/or purulent drainage), medical attention should be sought out as soon as possible. Trying

to dig out the nail yourself should be avoided as it can make the condition worse.

 

Surgical Treatment Options (What to Expect):

Slant Back Procedure

This procedure involves removing the distal wedge of the ingrown nail, the part that is digging into the skin and

causing pain. The removal usually does not involve the use of anesthesia but is also often only a temporary

solution. As the nail grows out, it will grow in the same direction, so there is likelihood that recurrence of the

ingrown toenail will occur.

 

Partial Nail Avulsion

A nail avulsion procedure requires numbing the toe first. Then, using sterile instrumentation, the involved

portion of the nail is freed from its surrounding soft tissue structures and is then cut and removed. The toe is

cleaned and covered with topical medication and dry dressings. 

 

Aftercare instructions are given for at-home care. Usually, you can return to work the next day, and activities

can be resumed when you feel comfortable, which may depend on the shoe gear worn. Any associated pain

and/or drainage usually resolve within 3-5 days after the procedure. The nail will grow back out again so there

is a chance of recurrence of the ingrown toenail.

Total Nail Avulsion

The total nail avulsion procedure is similar to the partial nail avulsion procedure, except the entire toenail is removed. Indications for having the entire nail removed may include a severe ingrown toenail with both sides of the nail involved, a fungal toenail with significant deformity, and a loosened toenail. 

 

Aftercare for a total nail avulsion is the same as the partial nail avulsion procedure.

 

Nail Matrixectomy

A matrixectomy procedure involves using a chemical to burn the root of the nail, which prevents it from

growing back out again. There is still a small chance of the nail growing back out, or having a nail spicule

develop, but the success rate of the procedure is about 85%. A matrixectomy procedure is more often is

performed after a partial nail avulsion procedure. Because a matrixectomy procedure is considered

permanent, it is often saved for recurring ingrown toenails. It should not be performed in the presence of an

infection. 

 

Aftercare for a matrixectomy procedure is similar to a regular nail avulsion procedure; however, the recovery

period is longer. Because of the chemical burn, the surrounding skin can become more irritated, causing mild,

localized redness and swelling to the toe, which may last up to two weeks after the procedure. 

PREVENTION

Preventing Ingrowth:

1. Make sure your shoes fit properly and are not too short or too tight.

2. Your toenails should be cut straight across and not rounded at the corners (1).​

 

Preventing Infection:

1. After noticing that you have an ingrown toenail, do not wait too long before seeing a physician for treatment, especially if it is not getting better or you notice it getting worse.

2. Avoid digging out the corners of the nail or the sections that are ingrown.

3. Do not share your nail clippers with others.

AT YOUR FEET CONCIERGE PODIATRY SERVICES

Dr. Falk is capable of performing all of the above ingrown toenail procedures. Most often, the procedure can be performed the same day as the consultation appointment. After reviewing your medical history, a thorough examination will be performed and the treatment options will be discussed. Then you and the doctor can decide the best treatment for you and your foot! Contact the doctor to schedule an appointment or to directly ask her a question.

Reference:

1. V-shaped, S. R. (2009). Management of the ingrown toenail.

Disclaimer: The above information is meant for educational purposes only and should not be construed as medical advice. Should you feel that you are suffering from an ingrown toenail or another foot-related issue, please schedule an appointment to see the doctor.

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