Ingrown and Fungal 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.

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.

People who have ingrown toenails commonly complain of swellling, redness, occasional drainage and or odor that 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.

Treatment for ingrown toenails usually involves a minor surgical procedure necessary to ease the pain and remove the offending nail border(s). Only a portion of the nail may need to be removed. It is very important not to ignore infected ingrown toenails since a skin infection from an ingrown toenail can spread to bone. There are options for surgical removal of the nail root to prevent regrowth the nail border or the entire nail plate if indicated.

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 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 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 McKinney Foot 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 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.

Nail plates that have been removed will grow back again within 5 to 9 months.

Dr. Silvers may recommend surgical treatment of nail disorders if the problem is severe or chronic. Most nail surgeries are performed at McKinney Foot Center under local anesthesia.

For some cases of ingrown toenails, only the portion of the nail that is growing into the skin is removed. If both sides of the nail are in grown, they may be removed during one procedure.

Permanent correction of an ingrown nail may be performed by surgically removing the nail border and the nail root or by placing a chemical over the nail root so that the growth cells are destroyed only in the problematic border(s). If there is an enlarged amount of skin around the nail border, this may be surgically removed as well. The entire toenail plate may also be removed if indicated and surgical excision by removing the nail root or by application of a chemical may be performed to prevent regrowth of the nail.

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.

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.