Podiatrists @ Placentia-Linda Foot & Ankle Group

INGROWN TOENAIL

Causes and Treatment

When foot pain and tenderness occurs in the side of the nail, the most common problem encountered is an ingrown toenail. The Podiatry presentation of an ingrown nail is usually a painful nail border with a red and swollen skin area next to the nail. Sometimes there is pus and a red colored skin growth called a pyrogenic granuloma. Infections are associated with this medical problem but many times in just removing the offending border, the infection does not need to be treated with oral antibiotics. Many people believe that cutting the nail too rounded will cause an ingrown nail. However, only the most distal part of the nail will be involved if in fact the nail was cut too short or rounded. If the entire side of the toenail is inflamed, then the cause is not how the nail was cut but how the nail is growing from the root of the nail called the matrix. If the entire side of the nail is involved, an ingrown nail procedure is required or the nail will continue to in grow as it comes to the end of the toe. Many patients have just the border avulsed by their family doctor to have the problem return in six months as the nail re-grows.

Treatment for an ingrown nails involves the use of Phenol which is a chemical that causes a alkaline burn to the skin that grows the nail and in so doing only that part of the nail that is ingrown is treated and the remaining healthily nail continues to grow. In the hands of an experienced Podiatric Surgeon, the procedure is very painless and the recovery is usually a non-issue. The toe is numbed but should not be a painful experience. In the wrong hands, a digital shot in the toe can be quite painful. The procedure takes about half an hour to an hour and no cuts are made in the skin. The nail is carefully separated from the healthy nail and the nail is then lifted off the matrix skin to allow the skin responsible for growing the nail to be treated for about three minutes with the Phenol medicine. After care is once a day soaking to twice a day soaking and covering the ingrown are with a band-aid. There are different types of procedures that are preformed but generally, the method using a scalpel to cut out the matrix is rarely indicated and will leave an unsightly scar. Laser for ingrown toenails is a gimmick and has a high rate of complication in having the ingrown nail return in strange directions causing intense pain. In fact, most Doctor's who use a Laser to treat ingrown nails will use Phenol to insure that the root is completely treated due to the high failure rate of using a Laser alone. The Laser is nothing more than a hot beam of light that is used to burn the tissue. There is no research that supports that causing a Laser burn is less painful and in most cases the laser treated ingrown nail is significantly more painful. In performing thousands of ingrown toenail procedures, and seeing much complication from Laser procedures, generally, no patient should have the Laser procedure as if this is a superior procedure over using a Phenol procedure.

If a patient has a chronic ingrown toenail, the skin under the nail becomes callused and the nail can no longer push through the skin and the nail must then lift off the nail in order to grow to the end of the toe. This is the cause many fungal nails infections that involve the great toe.  If you have a history of ingrown toenails and now have fungus nails, many times the cure to the fungus nail problem is having the chronic ingrown toenail corrected so the healthy nail can grow and remained attached to the nail bed.

Ultimately, ingrown toenails should be treated by permanent removal of the border that is growing into the skin of the toe. Avulsion of the border is used only as a temporary intervention and in four to six months the ingrown nail will return. Avulsion is appropriate if there is an important event that must be attended and after the event the ingrown nail is then treated. In just performing the avulsion with no other treatment plan, the problem of the ingrown nail will only get worse because the inflammation from the initial ingrown nail will make the next ingrown nail occurrence even worse.