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Posts for category: Nail Treatments

May 17, 2015
Category: Nail Treatments
Tags: ingrown toenail  

     INGROWN TOENAILS are one of the most common afflictions of the human foot.  They can occur at any age (I've seen them in babies only a few months old and in people in their 90's), and can occur on any toe.  The big toe, also called the hallux or great toe in Podiatric jargon, is the most common place to get an ingrown toenail.  The problem can be a chronic problem, coming up over a long period of time, and sometimes kept "under control" by the person who suffers from these, or can be very acute and come on suddenly with redness, swelling, drainage, and progressive infection.  In some cases, the infection can even enter the bone (osteomyelitis).   Once you have this problem, what can be done about it? 

    In MILD or borderline cases, where there is no infection, wearing wider or open toe shoes may help, at least for awhile.  This will in no way "fix" the problem, but it may give some relief until something more definitive is done, and may prevent infection from starting.  Soaking the toe in epsom salt may also help when the toe starts looking red, and infection is a concern.    I can recall in one case, about 15 years ago, that I , myself, had a very "borderline" ingrown nail.  It rarely bothered me, and I never did anything about it other than avoid tight fitting shoes.  As long as I stuck  with wing-tips, good fitting loafers, or running shoes, I had NO problems.   THEN - I went on a cruise.  I felt underdressed on the previous couple of cruises I was on, so I decided to rent a tuxedo.  Of course, it came with shoes, and they looked so good, and after all I paid for I HAD to wear them!   Big mistake!   First formal night, some mild discomfort, a little redness around the nail, and I just couldn't wait to get them off!   Then two casual nights, no problem with the loafers, well maybe a little tender, but not so bad.  Next time it was formal night, I was in agony. While the daily cruise planner said "guests are asked to remain in their formal attire thorughtout the evening" I disobeyed.   As soon as dinner was over, back to the cabin, and on went the loosest pair of shoes I had, which still hurt.  By the next day, the toe was fiery red, swollen, and a little drainage was present.  Thank God there were no more formal days!   Even on the semi-formal final night of the cruise, the wing tip shoes hurt very badly.  Out at sea - notmuch I could do.  As soon as I drove home form Fort Lauderdale where the cruise started and ended, I had the nail removed.  In this case a TOTAL TEMPORARY removal was in order.   IMMEDIATE relief ! 

    A total removal of the nail means the entire nail is removed.  A partial removal means just one, or in some cases, both sides or borders are removed.  A partial leaves most of the nail in place.  A partial can be permanent, meaning the root is removed or cauterized or can be just temporary, meaning the root or matrix is still in place and will grow back another nail (6-8 months is average, but can be quicker or longer depending on a number of things).  A total nail removal can also be temporary or permanent.  A total permanent removal means the entire root has been removed or "killed" and the nail will not grow back.  A total temporary removal means just the nail has been removed, and the entire nail will grow back.  

    When should a PARTIAL be done, and when should a TOTAL be done?   Part of it is personal preference on the part of the patient and the doctor doing the procedure, but in general my advice is as follows.  If only ONE side of the nail is ingrown/painful/infected, just remove one side.  This, in my opinion, looks the best and heals the fastest.  Even if it is a PARTIAL PERMANENT removal,  so little nail often has to be removed that it is often hard to tell anything has been done to the toe, once it is healed.  If the nail is very thick and/or incurvated (curved excessively so that it is not just a small part of the sides of the nail causing the problem), I feel it is better to do a TOTAL NAIL REMOVAL.  This can be temporary or permanent, depending on how long this problem has been present, the patient's circulation or bloodflow (or lack of it), the severity of the infection present, and how the patient feels about losing a toenail for good, as opposed to probably having it removed again in the future.  The real debate comes when the nail is normal in the center (not thckened or curved) and BOTH sides are ingrown.  In this case, there are good arguments for removing just the sides, and good reasons for removing the enitre nail.  It is really a judgment thing.  The doctor and patient need to talk, and a decision needs to be made what is in the best interest of the patient.  If the sides only are removed, especially if done permanently, the patient will still have part of the nail remaining.  Some patients, especially female patients, would rather have ANY nail than NO Nail.  The amount of nail however, may be only half of the normal nail, but could be up to 75%, depending on how much nail needs to be removed.  Also, removing BOTH borders of the nail at the same time, often loosens the nail.  This may not be a problem, but in young active patients, often getting their toes stepped on, or hitting them, they may lose the nail that is left.  Of course, this portion of nail WILL grow back, because the root or matrix is still present in the center.  Worse yet, I have known of a few cases where the nail was loose, was stepped on or hit several times, and did NOT come off, but started growing at an angle sideways, leading to a very abnormal and crooked toenail.  In most of these cases, the patient later elects to have the rest of the nail removed.  

    Ingrown toenails are one of the most common problems seen in the foot specialist's office, and usually the easiest to treat.  Permanent removal of the nail, when done correctly, can result in a 99%  cure rate, with no recurrence of nail.  It can result in a toe that feels, and often looks great.  It is one of the few procedures that can resolve a problem equally well whether it has been present 2 days or 20 years.


Richard S. Eby, DPM

EbyFootCare and Laser Center

7348 East Brainerd Road

Chattanooga, TN.  37421

(423) 760-3115

January 01, 2015
Category: Nail Treatments

BigNews.Biz - Apr 16,2013 - Chattanooga, TN, 17-APR-2013 - Dr. Richard Eby DPM, Chattanooga podiatrist, is pleased to announce that locals no longer have to put up with the pain and inconvenience of ingrown toenails. Ingrown toenails (onychocryptosis) are a commonly occurring issue usually found in the teenage years and beyond. The causes are found in improper trimming, poorly designed shoes and excessive sweating of the feet (hyperhidrosis).

According to Dr. Eby, speaking in a recent interview, "Ingrown toenails are usually caused by trimming toenails too short, particularly on the sides of the big toes. They may also be caused by shoe pressure (from shoes that are too tight or short), injury, fungus infection, heredity, or poor foot structure. Ingrown toenails occur when the corners or sides of the toenail dig into the skin, often causing infection."

"A common ailment", he continues, "ingrown toenails can be painful. Ingrown toenails start out hard, swollen, and tender. Left untreated, they may become sore, red, and infected and the skin may start to grow over the ingrown toenail."

Initially, the condition begins with pain in the specific nail. As the problem worsens, there may be drainage, difficulty walking and infection. This can be a particular difficulty with diabetic patients.

Prevention is the best way to avoid suffering the need for surgical therapy. Common therapy which can be begun at home, which will prevent many of the cases includes soaking the feet in warm soapy water several times daily. Advanced cases where infection is present may require antibiotics, but only at the instruction of the podiatrist.

Learn more about the prevention and care of ingrown toenails by visiting the web pages at today. Members of the press and individuals who have further questions about the details in this press notice are encouraged to contact Dr. Richard Eby DPM, Chattanooga podiatrist, at the location described below.

Contact Person Name: Dr. Richard Eby DPM
Address: 3603 Ringgold Road, Chattanooga, TN, 37347
Contact Phone Number: (423) 622-2664

December 07, 2014
Category: Nail Treatments
Tags: foot   heel   alternative   plantar fasciitis  

  Whether we are talking about PLANTAR FASCIITIS (the most common cause of heel pain) or RETROCALCANEAL SPUR with Achilles Tendonitis, there are MANY available treatments.  Traditonal treatments for heel pain, which are usually tried first, include stretching exercises, NSAIDs (oral anti-inflammatories), ice, heat, rest,  heel cups, heel lifts, shoe modifications, over the counter supports or insoles, custom orthotic devices, night splint/AFOs, topical pain creams and rubs, steroid injections, physical therapy, and of course if all else 

Then...there are a number of "alternative" treatments.  Some of these are fairly common, while others are a little more unusual.  Today, we will give a general overview of these available alternatives, all of which are non-surgical, and will cover many of them in much more detail in later posts.  So, here they are, in no particular order:  SHOCKWAVE (low energy and high energy), PRP (Platelet Rich Plasma), PEMF (pulsed electromagnetic therapy), OZONE INJECTIONS,  PODIATHERM,  and LASER TREATMENT.  I am sure there are others, but for now we are talking of treatments that are NON-SURGICAL and/or NONINVASIVE  (the Podiatherm is an exception because it does involve making a small incision) treatments for heel pain. 

One could also include herbal medications and acupuncture, but since I have no experience in these treatments, I will not cover these,  and I am sure there are some others that are used in certain cases.  What most of these treatments have in common is that they have little or no known (serious) side effects,  are done for the soft tissue problem causing pain and not bone, are usually not covered under traditional health insurance plans, are not done by a large number of physicians, but in many cases they are more "natural" type treatments that can sometimes result in very good outcomes and in some cases can result in a "cure" more than , say, a cortisone type injection, which almost always "wears off" after a period of time. 

Additionally, most of these involve either increased oxygen to the tissues - either directly, as in the case of ozone, or indirectly, as with PRP or Shockwave, where there is an increase in inflammation and then increased bloodflow to the area.  The increased bloodflow also resulting in increased oxygen in the tissues.   The Podiatherm is again, a bit of an exception here, because it is used more for nerve pain (entrapment) in the heel, and primarily works by heating up the nerve and making the nerve non-functional and basically causes an area to become "numb."   On the next few posts, we will go a little deeper into these treatments.


Richard S. Eby, DPM
(423) 622-2663


By contactus
May 18, 2012
Category: Nail Treatments
Tags: laser   fungus nails  

This is the newest way to rid of toenail fungus.  No one wants to expose their feet with a thick, discolored toenail. We call it " The Ugly Toenail Syndrome."  Many people choose this method instead of taking pills that can effect the liver or don't want to be bothered with having to remember to take that pill.  Laser is an easy way now for the patient that has that busy lifestyle and can only take a few minutes to help with the problem.  In our office you have a quick consultation to determine that laser is the best solution. Each treatment is ONLY 5 minutes per toe and it is done in 3 visits.  You come to my office once a month for your treatment, some people see results within that one month and you should see a nice result in 6 months.  I too have "The Ugly Toenail Syndrome" and have had the treatment done as works.  This is a procedure that insurance companies do not pay for, but it is well worth the money.  Call my office for an appointment and we can see what is the best option for you.