SAME DAY APPOINTMENTS AVAILABLE!

 

423-622-2663

 

 

 

By contactus@rebyfootcare.com
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 them....so 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

www.rebyfootcare.com

(423) 760-3115

Comments: