Incision & Drainage Procedure for Ingrown Toenails
Incision and drainage is a procedure performed on infected toenails, such as paronychias. When performing an incision and drainage (I&D) on a infected toenail, it usually does not involve an actual incision.
The procedure is outlined below:
1. The toe with the infected toenail is numbed with local anesthetic at the base of the digit in order for the patient to be able to tolerate the drainage of the infection.
2. A small sliver of toenail from one or both sides (and sometimes the entire toenail) is removed. When the portion of the nail is appropriately removed, the nail border or nail bed is inspected for any remaining pieces of toenail that may be causing infection to be present. All pus and fluid is drained from the nail and disinfected.
It should be noted that when infection is present, a chemical matrixectomy cannot be performed. If a chemical is used to the kill or destroy the nail matrix from which the nail plate grows from, this can create a small “burn” area. If any residual infection decides to invade the area of the chemical burn, this can lead to a more serious infection and possible invasion of the bone underneath the nail plate.
It should also be noted that patients who have an I&D performed must realize that there is a high probability that the nail border may come back ingrown again. Therefore, it is important to return to our office before the toenail becomes infected again and have a chemical matrixectomy performed. This will ultimately prevent re-growth of the ingrown toenail.
If you have an infected toenail, please call 972-542-2155 to schedule an appointment immediately.
Dr. Eric Silvers is a highly-trained foot and ankle surgeon specializing in the treatment and resolution of toenail pathologies.
He has offices located in McKinney, TX & Prosper, TX.
Please call 972-542-2155 to schedule an appointment today!
Subungual Exostosis
Subungual exostosis- is an overgrowth of bone along the dorsal aspect of the distal phalanx, the bone that sits under the toenail plate. A subungual exostosis can cause severe curvature of the nail plate which can lead to pain, onychocryptosis and infected ingrown toenails. Pain associated with an subungual exostosis can be addressed by padding the toe, removing the exostosis and/or the toenail plate.
Dr. Eric Silvers is a highly-trained foot and ankle surgeon specializing in the treatment and resolution of toenail pathologies.
He has office located in McKinney, TX & Prosper, TX.
Please call 972-542-2155 to schedule an appointment today!
Onychocryptosis
Onychocryptosis – is a curvature of the nail plate. It is often a painful condition in which the nail grows into one or both sides of the nail folds or flesh. Cryptotic nails may be either symptomatic or asymptomatic and also may become infected.
A common opinion is that nail plate enters inside the nail fold but an ingrown toenail may also be caused by an overgrown nail fold. Onychocryptosis can lead to infected ingrown toenails.
If the nail plate has irritated the nail fold for a long time, the tissue can develop increased callus or even red, beefy tissue called a granuloma. The definition of a granuloma is a “small nodule.” When granuloma tissue becomes infected, we refer to them as pyogenic granulomas.
In order for an onychocryptotic nail plate to become ingrown, it must penetrate the nail fold. This can happen simply due to the shape of the nail or due to a sliver or spicule of nail that is forced into the nail fold as the nail plate grows out.
Pain caused by an incurvated nail plate is relieved by excising or removing the portion of nail that is “dug” into the side of the nail fold.
Common causes for onychocryptosis include cutting the nails too short, fungus, tight shoes, and trauma caused the nail plate to grow ingrown.
Dr. Kory Williams and Dr. Eric Silvers are highly-trained foot and ankle surgeons specializing in the treatment and resolution of toenail pathologies.
Both physicians are located at both McKinney, TX & Prosper, TX.
Please call 972-542-2155 to schedule an appointment today!
Subungual Exostosis
True subungual exostoses arise from the tuft of the distal phalanx. They are composed of mature bone with a fibrocartilaginous cap. Lee et al (2007) noted that half of their subungual lesions were actually osteochondromas arising from the proximal part of the distal phalanx and covered with hyaline cartilage organised as in a growth plate. True exostoses are commonest in young adults with a female predominance. They mainly occur in the great toe, although they also occur in the lesser toes and fingers.
They present with a complaint of pain in the toe, sometimes localised to the nail fold. Sometimes the swelling itself may cause pressure on the shoe. Some have a history of trauma or previous nailbed surgery (which may have been for an “ingrowing toenail’ that was, in fact, the exostosis).
Examination shows a firm swelling under the nail, usually in the medial nail fold. It is usually covered with epidermis, but may be raw or granulating.
The main differential diagnosis is ingrowing toenail, with a nailbed tumour such as melanoma, squamous carcinoma or glomus tumour as a much rarer possibility.
The lesion normally continues to grow so is best removed when diagnosed. This can be done under digital block anaesthesia as a day case. Sometimes the nail fold can be elevated and preserved, but usually it cannot be separated from the lesion and must be sacrificed. Even with careful excision of the whole lesion, the recurrence rate averages about 10%. A few patients require removal of so much nail bed that there is significant post-operative nail deformity, so that plastic nail bed reconstruction may be consdered (Suga 2005).
If you feel you may have a painful subungual exostosis, please see Dr. Kory Williams or Dr. Silvers at Advanced Foot and Ankle Center for treatment.
References
- De Berker DA, Langtry J. (1999). Treatment of subungual exostoses by elective day case surgery. Br J Dermatol 140(5): 915-8
- Dalle S e al. Squamous cell carcinoma of the nail apparatus: clinicopathological study of 35 cases. Br J Dermatol. 2007;156(5):871-4
- Gray RJ et al. Diagnosis and treatment of malignant melanoma of the foot. Foot Ankle Int 2006; 27:696-705
- Lee SK et al. Two distinctive subungual pathologies. Subungual exostosis and subungual osteochondroma. Foot Ankle Int 2007; 28:595-601
- Suga H et al. Subungual exostosis: a review of 16 cases focusing on postoperative deformity of the nail. Ann Plast Surg. 2005;55(3):272-5
