WHAT IS AN INGROWN NAIL?
When any portion of the toenail pushes into the skin as it grows, it may become an ingrown nail. They can occur in patient of all ages. In some cases, even the whole nail can be involved. The medical term is onychocryptosis or paronychia.
WHAT IS THE PURPOSE OF OUR TOENAILS?
Our toenails have very little function. They do very little to protect the toe or the specialized skin under the nail. Loss of a portion or the entire toenail does not restrict people from any function or activity nor does it increase any chance of infection or damage to the toe. If an entire nail must be permanently removed the nail bed once healed may be painted with nail polish if one so desires. There are also false toenails that can be applied to the nail bed for aesthetics if one desires.
WHAT ARE THE SYMPTOMS OF AN INGROWN NAIL?
Patients will complain of mild to severe pain usually in the corner or side of the nail. The pain starts as a mild achy pain. As the nail continues to move into the skin, the pain will become more severe. There will be redness and swelling around the nail. An infection is usually present and can present as a pus pocket under the skin. Some patients will even see pus drainage from the area. As the nail continues to go into the skin, there is a reaction of overgrowth tissue that can develop. This extra tissue is very vascular and tends to bleed easily if bumped. In very severe cases when left untreated, a cellulitis, or streaking severe infection can develop. A portion of nail or the whole nail could be involved.
WHAT ARE THE CAUSES OF AN INGROWN NAIL?
An ingrown nail occurs when the nail produces a sharp edge and punctures the skin as it grows forward each day. This may occur from trauma to the nail. The trauma could come from an external force such as a kick to a soccer ball cracking the nail, or to tight shoes. In most cases an ingrown nail occurs due to the poor cutting of the nail. This can happen at home, or even at the pedicurist. When the nail is cut too short or at an angle, a sharp edge is left on the nail. Days later, this sharp edge can cut into the skin and the ingrown nail begins.
Some patients are prone to ingrown nails if their nail is severely curved or thickened or to wide. Those with fungal infection to the root of the nail are also prone to ingrown nails.
HOW IS AN INGROWN NAIL DIAGNOSED?
An examination of the nail and the surrounding skin is the most common way to verify the presence of an ingrown nail.
HOW IS AN INGROWN NAIL TREATED?
Mild to moderate cases:
In case when the ingrown nail is mild and has just started, a home course of therapy may eliminate the pain. The patient will be asked to soak the foot in warm water and salts each day for 20 minutes. The area should
then be covered with a bandage and antibiotic ointment. This regimen will soften the nail and the surrounding skin and help the nail to come out of the skin as it grows. The doctor may use an instrument to elevate the nail out of the skin to aid in its growing the proper way. Cutting of the nail is not indicated as it will create another sharp edge and the problem will recur.
Patients who have moderate to severe ingrown nails may require more aggressive treatment. In these cases, the affected portion of the nail may need to be removed permanently. This is called a matrixectomy.
PARTIAL MATRIXECTOMY PROCEDURE:
The procedure is performed in the office setting in less than 20 minutes. The patient is given 2 small injections at the base of the toe to numb the affected area. The toe is then prepped for the procedure. The affected area of the nail is lifted away from the nail bed and nail root using specialized instruments. This is done without any incision in the skin. The offending nail is then removed from the healthy nail and nail root. Any pus or granulation tissue is removed. The nail root is lifted from the underlying bone and a portion of the underling bone is scraped. A specialized acid mixture called Phenol is then carefully placed over the removed root (matrix) of the nail to kill the root cells. The area is then flushed with alcohol followed by numbing solution flushing. There is minimal bleeding and no pain during the procedure. The toe is then wrapped with light bandages. The patient will be asked to perform a home therapy protocol to treat the area during healing. Patients typically experience minimal discomfort and is restricted from public hot tubs during the 1 ‘t week. There is a large gauze wrap for the first 12 hours. Then may reduce to a band aid for about 2 weeks. The patient should not see any growth of the nail at this affected area.
TOTAL NAIL MATRIXECTOMY:
Some patients may have a problem with the entire nail. ln these cases, the whole nail may need to be removed temporarily or permanently. The same procedures are followed as above, yet removing the entire nail. No special attention is needed to the skin under the nail once healed.
SURGERY FOR AN INGROWN NAIL FOR YOUNG CHILDREN OR SQUEAMISH ADULTS:
Some cases when the patient is a young child or any one including squeamish or very nervous adults who just don’t want to be awake for this procedure may be brought into a same day surgical center to have the nail procedure performed while under general anesthetic.