When
foot pain and tenderness occurs in the side of the nail, the
most common problem encountered is an ingrown toenail. The Podiatry
presentation of an ingrown nail is usually a painful nail border
with a red and swollen skin area next to the nail. Sometimes
there is pus and a red colored skin growth called a pyrogenic
granuloma. Infections are associated with this medical problem
but many times in just removing the offending border, the infection
does not need to be treated with oral antibiotics. Many people
believe that cutting the nail too rounded will cause an ingrown
nail. However, only the most distal part of the nail will be
involved if in fact the nail was cut too short or rounded. If
the entire side of the toenail is inflamed, then the cause is not how the nail was cut but how the nail is growing from the root of the nail called the matrix. If the entire side of the nail is involved, an ingrown nail procedure is required or the nail will continue to in grow as it comes to the end of the toe. Many patients have just the border avulsed by their family doctor to have the problem return in six months as the nail re-grows.
Treatment for an ingrown
nails involves the use of Phenol which is a chemical that causes
a alkaline burn to the skin that grows the nail and in so doing
only that part of the nail that is ingrown is treated and the
remaining healthily nail continues to grow. In the hands of an
experienced Podiatric Surgeon, the procedure is very painless
and the recovery is usually a non-issue. The toe is numbed but
should not be a painful experience. In the wrong hands, a digital
shot in the toe can be quite painful. The procedure takes about
half an hour to an hour and no cuts are made in the skin. The
nail is carefully separated from the healthy nail and the nail
is then lifted off the matrix skin to allow the skin responsible
for growing the nail to be treated for about three minutes with
the Phenol medicine. After care is once a day soaking to twice
a day soaking and covering the ingrown are with a band-aid. There
are different types of procedures that are preformed but generally,
the method using a scalpel to cut out the matrix is rarely indicated
and will leave an unsightly scar. Laser for ingrown toenails
is a gimmick and has a high rate of complication in having the
ingrown nail return in strange directions causing intense pain.
In fact, most Doctor's who use a Laser to treat ingrown nails
will use Phenol to insure that the root is completely treated
due to the high failure rate of using a Laser alone. The Laser
is nothing more than a hot beam of light that is used to burn
the tissue. There is no research that supports that causing a
Laser burn is less painful and in most cases the laser treated
ingrown nail is significantly more painful. In performing thousands
of ingrown toenail procedures, and seeing much complication from
Laser procedures, generally, no patient should have the Laser
procedure as if this is a superior procedure over using a Phenol
procedure.
If a patient has a chronic
ingrown toenail, the skin under the nail becomes callused and
the nail can no longer push through the skin and the nail must
then lift off the nail in order to grow to the end of the toe.
This is the cause many fungal nails infections that involve the
great toe. If you have a history of ingrown toenails and
now have fungus nails, many times the cure to the fungus nail
problem is having the chronic ingrown toenail corrected so the
healthy nail can grow and remained attached to the nail bed.
Ultimately, ingrown toenails
should be treated by permanent removal of the border that is
growing into the skin of the toe. Avulsion of the border is used
only as a temporary intervention and in four to six months the
ingrown nail will return. Avulsion is appropriate if there is
an important event that must be attended and after the event
the ingrown nail is then treated. In just performing the avulsion
with no other treatment plan, the problem of the ingrown nail
will only get worse because the inflammation from the initial
ingrown nail will make the next ingrown nail occurrence even
worse.