You have suffered for some time with a painful ingrown toenail. You have clipped a "V" in the middle of the nail, maybe pushed cotton under the nail fold hoping against hope that the pain will just go way. Unfortunately, these old fashioned remedies just don’t work and can increase the risk for infection. Many of us will even try a little bathroom surgery hoping relief is one clip away.
You have come to a point where you finally realized that home treatment is not enough and you, or your child, needs a little help. Treatment for ingrown toenails should be obtained in a timely manner in order to prevent the risk of infection which increases pain and prolonged recovery period. Options for treatment fall into five categories; Slant back procedure, partial removal of nail, total removal of nail, partial permanent removal of nail and total permanent removal of nail. Choice is based on the severity of nail infection, pain and past history in ingrown toenails. Most importantly, nails can be treated successfully during your initial office visit, even if a procedure is needed.
The following article will discuss which treatment option is right for you and most importantly what to expect through the process.
Slant Back Procedure
This procedure is performed in cases where offending nail pain is caused by a mildly incurved nail. The procedure involves an angled cut performed to the corner of the nail extending to just before where the nail cuts into the skin. This procedure is relatively painless and typically performed when cause is improper nail trimming.
- Dressing: If drainage is noted after nail trimming or nail has already cut into skin a bandage with some sort of antibacterial ointment or cream may be required for several days. Bandage will be changed once daily until drainage ceases. Normal bathing of foot can occur.
- Pain Management: If pain is noted over the counter anti-inflammatories or Tylenol suffice for pain control. After slant back is performed pain typically reduces almost immediately and no pain medication is required.
- Activity: After a slant back patients typically return to full activity immediately, including athletic activities. Swimming in lakes or rivers is not recommended if broken skin or drainage is present.
A Follow-up appointment is required in several weeks to evaluate healing.
Partial Nail Removal (Partail Nail Avulsion)
This procedure is performed in cases where active infection of the skin surrounding the nail is present, or when area of incurved nail is too far back to remove comfortably without anesthetic. The procedure involved trimming a thin piece of nail down to the root, therefore allowing infection to be drained out and removal of painful ingrown nail.
The procedure starts by numbing the toe with local anesthetic at the base of the affected toe. The toe will become numb after about 10 minutes. The toe will then be scrubbed clean before the start of the procedure. Once numb, the offending nail will be clipped from the tip of the toe to its base under the cuticle removing the nail root, while maintaining a cosmetically normal appearance of majority of nail. At this time, any pus or drainage is flushed with saline. Due to infection, oral antibiotics may be required for approximately 1 week. The toe will remain numb for approximately 6-8 hours.
- Dressing: Your doctor will apply antibiotic ointment or cream to procedure site followed by a gauze bandage and a compressive wrap. Bandages are changed daily at home and can be left in place while bathing to make removal easier. Dressing may be made smaller each day based on how much drainage is noted on inner dressing. Drainage typically lasts for about one week at which time dressings can be discontinued.
- Pain Management: If pain is noted over the counter anti-inflammatories or Tylenol suffice for pain control. After partial nail avulsion is performed pain typically improves compared to pre-procedure pain from ingrowing nail.
- Activity: After partial nail avulsion, patients should avoid physical activity for several days to allow for nail fold to begin healing. Activity may begin after several days, but expect some discomfort. Swimming in lakes or rivers is not recommended if broken skin or drainage is present.
Follow-up Appointment is required in 1-2 weeks to evaluate healing. Site of nail removal will grow back in 8-12 months.
Total Nail Removal
This procedure is seldom performed, but may be discussed in cases where infection has spread underneath the nail plate. Procedure is the same as partial nail avulsion with the addition of removal of the entire nail plate. Toe is bandaged in much the same manner as in a partial procedure, but pain and healing tend to take a week or so longer. After healing is complete the site of nail removal gets covered with healthy skin that from a distance can resemble a normal nail. Over the course of 8-12 months a new nail grows back.
Permanent Partial Nail Removal (Matrixectomy)
This procedure is performed in cases where the patient has had chronic ingrown nails, or previous treatments have failed to prevent recurrence. The procedure involved trimming a thin piece of nail down to the root, and then adding a chemical called Phenol directly to the nail bed where the nail originates. This prevents these cells from growing a new nail along affected border, therefore, preventing recurrence. This procedure cannot be performed when infection/pus is within the toe.
The procedure starts by numbing the toe with local anesthetic at the base of the affected toe. The toe will become numb after about 10 minutes. The toe will then be scrubbed clean before the start of the procedure. Once numb, the offending nail will be clipped from the tip of the toe to its base under the cuticle removing the nail root, while maintaining a cosmetically normal appearance of majority of nail. At this time, 3-4 applications of Phenol will be performed with a cotton swab and then flushed with saline. Phenol is approximately 95% effective in preventing regrowth of nail. The toe will remain numb for approximately 6-8 hours.
- Dressing: Your doctor will apply antibiotic ointment or cream to procedure site followed by a gauze bandage and a compressive wrap. Bandages are changed daily at home and can be left in place while bathing to make removal easier. Dressing may be made smaller each day based on how much drainage is noted on inner dressing. Drainage typically lasts for about one week at which time dressings can be discontinued.
- Pain Management: If pain is noted over the counter anti-inflammatories or Tylenol suffice for pain control. After partial nail avulsion is performed pain typically improves compared to pre-procedure pain from ingrowing nail.
- Activity: After partial permanent nail removal, patients should avoid physical activity for several days to allow for nail fold to begin healing. Activity may begin after several days, but expect some discomfort. Swimming in lakes or rivers is not recommended if broken skin or drainage is present.
Follow-up Appointment is required in 1-2 weeks to evaluate healing.
Complete Permanent Nail Removal (Matrixectomy)
This procedure is seldom performed but in some patients may be discussed in cases of chronically ingrown toenails or in cases where repeated partial nail procedures have failed to eliminate pain. Procedure is the same as permanent partial nail avulsion with the addition of removal of the entire nail plate. Toe is bandaged in much the same manner as in a partial procedure, but pain and healing tend to last several weeks longer. After healing is complete the site of nail removal gets covered with healthy skin that from a distance can resemble a normal nail.
Follow-up Appointment is required in 1-2 weeks to evaluate healing.
Realistic Expectations:
Ingrown toenails often begin through no fault of our own, but an ounce of prevention can go a long way. After you have your procedure performed make sure that you cut your nails straight across, do not tear nails, keep skin soft at edges of nails with lotion, and wear shoes that allow for enough space for the toes to prevent pressure that can lead to recurrence.
If an ingrown toenail recurs, do not hesitate to call your physician and make an appointment immediately before infection occurs. Infection only serves to lengthen recovery and pain from this debilitating condition.
