Friday, November 8, 2013

Ingrown toenails - 5 important facts and how are they treated?

Have you ever experienced pain, redness, swelling, and even drainage from the "inner" fold of your toenails? Have you been told that this can eventually "grow out"? In reality, ingrown toenails are common in the practice of the foot and ankle specialist but their treatment carries some misconceptions.

Presentation of an ingrown nail with localized infection

Note drainage from inner fold of nail consistent with infected ingrown nails

Here are 5 things you must know about ingrown toenails:
1) Untreated ingrown toenails can cause infections in the skin, bone, and result in life-threatening infections also referred to as "sepsis"
2) Genetics and foot-architecture can play a role for ingrown toenails
3) Cutting toenails too short and into the "corners" can cause ingrown toenails
4) The great (big) toenail is most commonly affected
5) Only definitive way to treat ingrown nails is surgical

Surgical treatment involves an array of different local procedures to remove the "ingrown" component of the nail without compromising the remainder of the nail. In most cases, a chemical treatment is also applied to prevent the nail from growing back "ingrown".

So what does the procedure entail?
1) Typically an in-office setting with local anesthetic infiltrated to "numb" the toe
2) Removing the ingrown component of the nail from the tip to the root
3) Draining and debridement of any infected tissue or abscess.
4) Application of chemical treatment to inhibit nail (matrix) cells from growing back in the in-grown position
5) Application of an antimicrobial dressing that stays on for one day.

Post-operative management?
Although most foot and ankle specialists have different protocols, on average most would agree on a protocol that involves the following:
1) Daily dressing change with a Bandaid until the drainage from the toe completely resolves
2) Following with your provider between 7-14 days after the procedure to ensure no infections. At that point, patients are typically given a prescription for topical solutions to prevent infections and promote the healing of the skin.

If you have any questions about ingrown toenails then please consult with your foot and ankle specialist.

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