North Dallas Ingrown Toenail Specialists
A toenail becomes ingrown when the side or sides of the nail plate begin to irritate and cause pain to the adjacent nail fold. Unless that patients suffers from a nerve condition such as neuropathy, ingrown toenails are painful. Other associated findings may include redness, swelling, drainage, red streaking from the base of the toe towards the foot, and sometimes an odor.
The cause of ingrown toenails are numerous. Blunt trauma to the top of the toenail may force the edges of the toenail into the inner or outer sides of the adjacent nail folds. Repetative micro traumas such as tight fitting shoegear can force the toenail into the nail folds over time. Thick, fungal toenails can also become ingrown a toenail plate become disfigured as the fungal toenail infection progresses. Improper trimming of nails may leave a spike of nail in the corners that is prone to dig into the nail fold as the toenail grows out. Often, teenages pick and/or peel at their toenails and this can lead to nail fold irriation that can turn into an infection.
If you suspect that you may have an ingrown toenail, the best thing to do is to see a foot and ankle specialist. The physicians at Advanced Foot and Ankle Center have years of experience intreating ingrown toenails. Both physicians can offer different options based on the severity of the ingrown toenail(s).
If you cannot get into Advanced Foot and Ankle Center to see Dr. Silvers or Dr. Williams promptly, there are some things that you can do at home to begin treatment. These include applying a triple antibiotic ointment to the ingrown portion of the toe and soaking the foot in espsom salt, vinegar and warm water. Please be advised that this is not a substitute for medical treatment of your ingrown toenail.
Medical treatment for ingrown toenails include procedures that include removing the side of the nail plate or the total nail plate and either allowing it to grow back to perminant procedures that prevent the nail plate from growing back. If the nail fold needs to be remodeled, various soft tissue procedures can also be performed when needed.
Permanent treatment of an ingown toenail is called a matrixectomy. The nail root is referred to as the nail “matrix” and “ectomy” means “removal of.” When a matrixectomy is performed by the physicians at Advanced Foot and Ankle Center, it can be done with either chemicals that destroy the cells in the nail root, or the nail root can be cut out surgically. 98% of the time, chemicals are used to destroy the nail matrix at Advanced Foot and Ankle center. The physicians at Advanced Foot and Ankle Center reserve surgical removal of the nail matrix for cases where there is regrowth after a chemical matrixectomy.
Healing from an ingrown toenail procedure can take 1-4 weeks and the healing time is dependant upon how bad the ingrown toenail was, the procedure performed and the patient’s own ability to heal. After an ingrown toenail procedure, the patient will need to care for his or her toe at home by applying topical medications such as Amerigel, triple antibiotic ointment and gauze and or a band aid. Sometimes we will recommend soaking after the procedure.
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.
Nail plates that have been removed will grow back again within 5 to 9 months if a nail matrixectomy was not performed. Post operative pain is typically very minimal. If the entire nail plate is removed, versus just the side or sides, then pain medications may be prescribed to the patient along with oral antibiotics.
Below are more nail disorders that can be linked to ingrown toenails.
NAIL DISORDERS
Many nail problems are caused by improper trimming, acute injuries or blunt trauma over an extended period. Some nail disorders are also congenital.
Painful ingrown toenails my be congenital, caused by an overcurvature of the nail, or an imbalance between the width of the nail plate and the nail bed. However, most ingrown nails are caused by cutting the nail too deeply into the tissue adjacent to the nail plate. Toe injuries that change the nails contour also can lead to an ingrown toenail. Toe deformities (such as a bunion that forces the great toe to lean into the second toe), narrow or high heeled shoes can put pressure between the nail and the soft tissues, which may eventually cause the nail to grow into the skin.
Ingrown nails can be accompanied by other toe disorders, such as excess surrounding tissue or an outgrowth of bone beneath the nail.
Fungal infections usually present themselves in the toenail where the environment is ideal for their growth (dark, warm and moist).
Various types of fungi are present everywhere in the environment. Most fungi are harmless until they penetrate the skin. A fungus can invade the skin or nail after a minor cut, or after injury that forces the fungus into the nail plate after usually after the nail plate becomes slightly separated from the nail bed.
Fungal infections of the nail plates and nail bed are quite common. Many geriatric and diabetic patients have fungal infections in their toenails.
Fungal infections may cause the toenail to thicken and become yellow or brownish in color. As the fungus grows, foul smelling, moist debris may be present. Pressure form a thickened nail or the build-up of debris may make the toe painful. Many people who have fungal infection of their toenail(s) become self-conscious due to the thickness and discoloration. However, there are treatments!
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 burr. Filing will not prevent the infection from spreading.
Oral and topical medications may be prescribed. Dr. Silvers, Dr. Williams and staff have Tineacide (anti-fungal cream) in the office for patient convenience. These medications work the best when only a small portion of a nail is infected. Oral medication may or may not completely eliminate the fungus. It may take 9-12 months to see results from the oral medications and Dr. Silvers and Dr. Williams may find it necessary to monitor liver enzymes prior to and during the course of oral anti-fungal treatment.
Eliminating the fungal infection, in some cases, can only be achieved by permanent removal of the nail plate.
Subungual Hematomas (blood underneath the nail(s)) are a very common result of active lifestyles. They are especially common among people who jog of play tennis. The toes repeatedly rubbing against the shoe cause subungual Hematomas.
A hematoma might indicate a fractured bone underneath the nail, especially after an injury (such as dropping a heavy object on the end of the toe). A Doctor of Podiatric Medicine should examine the toe. At Advanced Foot & Ankle Center, we may take an x-ray to determine the most appropriate treatment.
If the hematoma is treated within the first few hours, Dr. Silvers and Dr. Williams may create a tiny hole in the nail plate, which releases the blood from 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 cleansed.
Dr. Silvers and Dr. Williams may recommend surgical treatment of nail disorders if the problem is severe or chronic. Most nail surgeries are performed at Advaned Foot and Ankle Center under local anesthesia.
Bone directly underneath the nail plate may become enlarged, developing a spur or outgrowth that can deform the nail plate or lead to an ingrown nail. Using a rasp or small burr to level off the spur may perform removal of excess bone.
Most people experience very little pain immediately following nail surgery, and during the healing process, which lasts approximately 2-4 weeks (depending on the procedure). If bone has been removed during surgery, a longer healing process should be anticipated.
Dr. Silvers and Dr. Williams and the staff at Advanced Foot & Ankle Center will give you postoperative care instructions along with any medication that are necessary.
What are Hammertoes?
Hammertoes
An inherited muscle imbalance or abnormal bone length can make one or more small toes buckle under, causing their joints to contract. This in turn causes the tendons to shorten. Corns (build-ups of dead skin cells where shoes press and rub) often form ojn top of the contracted joints, and may become irritated and infected. Hammertoes are surgically corrected by various means depending on the flexibility or rigidity of the deformaty. Sometimes the hammer toe is repaired by a procedure known as an Arthroplasty where a portion of the contracted joint is removed. Other times the deformity is repaired by a procedure known as an Arthrodesis where the contracted joint is repaired by fusing the joint together.
Often, a foot with a bunion will also have a hammertoe. Overtime, the bunion slants the big toe toward and then under the second toe (the most often “hammered” toe), raising the second toe to a claw-like position.
Hammertoes can also occur when a bunion is not present. Those people with high arches, a tendency to rotate theri feet inward when walking, or rheumatoid arthritis, are especially susceptible. Once stiffened into position, hammertoes rub against shoes and cause painful corns and calluses.
Extracorporeal Shock Wave Treatment for Heel Pain
A revolutionary new treatment for plantar fasciitis has arrived and is now offered at McKinney Foot and Ankle Center. Many people suffer from the classic symptoms of plantar fasciitis. These symptoms typically are heel pain the first few steps in the morning and/or after rest. This pain usually subsides some after walking for five to ten minutes. As the condition progresses, patients may experience heel pain late in the day as well. Extracorporeal Shock Wave is now FDA approved to treat plantar fasciitis.
“Extracorporeal” means “outside the body.” Shock waves are created by very strong acoustic (sound) energy. The ESW treatment is preformed with a device called the OssaTron. The OssaTron is a shock wave generator very similar to the shock wave devices used to treat kidney stones without surgery (Lithotripsy). The shock waves are created by a spark plug that is enclosed in a soft plastic dome filled with water. During ESW treatment, this dome is placed close against the heel so that the shock waves pass through the dome into the heel. ESW is a non-invasive way of treating heel pain. There are no incisions, stitches or dressings associated with ESW treatment. The day of the ESW treatment: Dr. Silvers will probably ask you to come to the surgery center a few hours before your ESW treatment is scheduled. You should wear shorts or loose fitting clothing that can easily be rolled up to the knee of your affected leg. Otherwise, you may be asked to change from your own clothes into a hospital gown. The staff may take your temperature, pulse and blood pressure and ask you some questions about your general health. They also will make sure you have signed a consent form for the ESW treatment. The ESW treatment may cause some discomfort, so an anesthetic is commonly given before the procedure. Usually, this is a local anesthetic or a regional anesthetic called a heel block. During the ESW treatment, you will be asked to rest comfortably on your back while Dr. Silvers holds your foot up to the OssaTron shock head. An ESW treatment for chronic proximal plantar faciitis usually takes about 30 minutes. The ESW treatment is performed as an outpatient procedure. No overnight hospital is necessary. After the ESW treatment: Immediately after treatment, you will stay at the hospital or surgery center until the anesthetic wears off enough that it is safe for you to walk. Dr. Silvers will probably ask you to restrict “stressful activity” involving the treated foot for four weeks after treatment. “Stressful activity” may include running or jogging, doing heavy housework or yard work, and participating in sports. Some patients need a mild pain medication following ESW treatment. Although some patients feel immediate relief from pain after the ESW treatment, it is more common for it to take up to six weeks for pain relief to begin. Dr Silvers will ask you to return to the office for a follow up visit after ESW treatment. How can I get more information about ESW treatment for heel pain? Talk to Dr. Silvers. In order to use the OssaTron to treat chronic proximal plantar faciitis, Dr. Silvers had to complete a specialized training program. The training program not only allowed Dr. Silvers to learn how to perform the ESW treatment, but it also included information about shock wave energy in general, and information from the OssaTron clinical study. Therefore, Dr. Silvers is the best person to talk with if you have any questions or concerns about ESW treatment for chronic proximal plantar faciitis with the OssaTron. Other treatments available for treating chronic proximal plantar faciitis: Many other people get better after trying one or several conservative treatments, which include:
In difficult cases of chronic proximal plantar fasciitis, open or arthoscopic surgery may be performed. Who should consider having ESW treatment for proximal plantar fasciitis? ESW treatment with the OssaTron is for patients who have had heel pain for at least six months and who have tried other methods for treating their heel pain. In the OssaTron clinical study, the treated patients had failed to respond to at least three attempts at conservative treatment: two prior courses of non-invasive treatment, including physical therapy and the use of an orthotic device; and one prior course of pharmacological treatment. ESW treatment with the OssaTron is for patients who can tolerate anesthesia prior to the ESW procedure. ESW treatment with the OssaTron is painful. ESW treatment with the OssaTron is for patients who can tolerate hearing protection to reduce the risk of hearing impairment due to the sound of the OssaTron. Contraindications:
Because the OssaTron has not been tested on people who have the following conditions, its effect, safety, and effectiveness on someone who has one of the following conditions is unknown:
Dr. Silvers can provide you with additional information about these and other conditions and how they might affect the decision to perform ESW treatment. Side Effect and Complications:
If you have any questions about ESW or if you would like to schedule an appointment with Dr. Silvers, please call McKinney Foot and Ankle Center at (972) 542-2155. |
