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Footnotes / Blog

Ingrown Toenails…

Thursday, September 23rd, 2010 Kenneth Donovan

…by far my favorite thing to treat in the office, as patients get immediate relief from treatment w/in 48hours.

Ingrown toenails come in 2 different flavors; infected and non-infected, with varying degrees of pain. All ingrown toenails are caused by the nail plate digging into the skin on the side of the nail. Some people nails are naturally more curved (a term we call incurvated) than others, and therefore are more prone in ingrown toenails in their lifetime. Nails can also become incurvated secondary toe nail fungus or trauma. A lot of pregnant and post-partum females are seen with ingrown toenails due to the pedal swelling caused by pregnancy. Lastly of course, there’s the dreaded ingrown toenails caused by digging in the corners by either the individuals themselves or at nail parlors.

No matter how you got them, there’s one of 3 ways to treat them depending on the situation. First there’s the “slant back” procedure. This procedure is reserved for mild cases of ingrown toenails that are non-infected. Usually the patient complains of at the front corner of the nail near the end of the toe. In this procedure we remove the offending portion of nail using a special surgical blade, and under the cold spray anesthesia thereby causing minimal pain.

The next procedure is a partial nail avulsion procedure with or without incision and drainage of abscess. In this procedure we use Lidocaine (a form of novacaine) to numb up the affected toe. Once the toe is numb and nail splitter is used to take a sliver of nail from the offending side, all they way back to the nail root. The piece of nail is removed, and the area is inspected of any abscess (ie. collection of infection fluid), and if there is some it is drained completely. This procedure is reserved for more moderate to severe ingrown toenails that are infected.

Lastly, is the Phenol and Alcohol procedure. This procedure is the same as the partial nail avulsion procedure, however can only be done in the presence of no infection. In this procedure, once the nail is removed, the nail matrix (which grows new nail plate) is burned w/ Phenol (a special acid) to kill those cells, thereby preventing that portion of the nail from growing back. This procedure is usually reserved for people w/ recurrent ingrown toenails.

Typically the post-op period for these procedures is painless. Patients are instructed on doing daily foot soaks for a period of 2 weeks after the procedure. Antibiotics may be indicated in the presence of infection.