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 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.
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 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 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 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 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 the staff at Advanced Foot & Ankle Center will give you postoperative care instructions along with any medication that are necessary.