Ingrown Toenails

An ingrown toenail is defined as a nail that has pushed itself and essentially, grown into the skin surrounding the nail, known as the "nail fold".  Not all ingrown toenails are painful.  It is only when enough of the nail has grown into a nail fold that the nail fold becomes irritated enough to cause discomfort.   If this condition is allowed to progress, infection can actually occur within the nail fold.  This infection is known as a "paranychia".  An abscess, or a collection of pus, can also result if an ingrown toenail is allowed to progress untreated. 

There are different forms of treatment depending on the severity of the ingrown toenail.  

There are many cases where simply tucking a small piece of cotton under the leading edge of the nail is enough to lift the nail off of the nail bed allowing the nail enough clearance to avoid further irritation.  In most cases, however, once the nail reaches a point  to cause irritation, cotton is not enough treatment. 

The most lenient form of more invasive treatment, is simply trimming back the portion of the nail that is growing into the nail fold causing the irritation. Removing this triangular piece of nail is just enough to reduce the pressure against the nail fold.  This in turn completely relieves the pain. This procedure is known as a "slant back" procedure.  This is easily accomplished if the nail is not to the point where it has infected the nail fold.  This is also a very good option for a nail that has only just recently become ingrown or in patients with no real previous history of ingrown toenails.  An injection is not necessary with this form of treatment using appropriate instrumentation and performed by a podiatrist. 

The next form of treatment is known as a partial "nail avulsion".  This is a more detailed procedure and does require the use of a local anesthetic.  Once the toe is numb, and longer more rectangular-shaped piece of nail is removed along the edge of the involved nail fold all the way to the cuticle.  This procedure is usually well suited in patients where healing a more invasive procedure is questionable.  These are patients with a poor blood supply or patients that have a poor immune system.   This is also a good procedure in cases where ingrown permanent removal of this offending portion of nail is not possible because of the severity of infection. 

And most definitive way of treating an ingrown toenail is with a procedure known as a "matrixectomy".  Broken down, "matrixectomy" means removal or "ectomy" of the nail "matrix" which is the root of the nail lying under the cuticle.  The "root" is the portion that actually grows the nail.  By permanently removing the problematic portion of the root of the nail, the chances of a return of an ingrown nail is very slim.  

The best form of treatment of course this preventing the problem in the first place.  Simply making sure that your nails are trimmed, not torn short, goes a long way in prevention of ingrown toenails.  Trim them straight across and use a file to smooth out the rough corner edges.  A very short nail can become prone to getting ingrown.  Leaving a little bit of white on the end ensures that the nail is not too short.  

If you have reached the point where you have discomfort from an ingrown nail, do not delay in visiting your podiatrist.  Remember, an infected toenail limits treatment options and limits your ability to move on with other priorities!