Ingrown Toenail Category

Part C – Postsurgical Care of Ingrown Toenails

Welcome to the postsurgical care segment of our 3-part series, The ABC’s of Ingrown Toenail Surgery. In Part A you learned about the anatomy and manifestation of an ingrown toenail, and in Part B we emphasized surgery basics and the urgency of an hour spent in the podiatrist’s office when your symptoms have gotten out of control.

Now you’ve visited your podiatrist and resolved your ingrown toenail condition with an in-office procedure; the matrixectomy. Maybe a few extra steps were required in your individual case, but it’s over, and your new path is recuperation and rejuvenation.

Postsurgical Care Matters

An in-office procedure is something you walk away from when it’s finished. No hospital stay, nurse attendants, constant sleep interruption, beeping machines, IVs, and no tasteless kindergarten food. You’re back at work, and sleeping in your own bed, with the kids’ voices within earshot, and the pets on your lap. Home is good.

At the same time, you will be given instructions which are vital to attend to. The more compliant you are with the directions that you have been given, the faster and more thorough will be your healing. Should you fail to soak, as below, the nail which is dissolving (according to plan) will instead get caught beneath the skin – and then you’re back to pain, redness and swelling!

• Soak the treated area 3 times a day in warm water and Epsom Salt (follow package instructions) starting the day after your nail surgery. Your shower can count as 1 of those soakings.
• Soak the toe with the bandage on. If the bandage is still in place on the 3rd day, remove it.
• Follow all soakings with application of an antibiotic ointment such as Neosporin and a Band-aid.
• When soaking, use your finger to pull the nail fold (skin) away from the nail. This will help to open any scar tissue that has formed in the area and allow the warm water to clean the surgical area.
• Continue this treatment until your follow‐up appointment.
• Ice the area for 10 minutes and take 600mg of ibuprofen every 8 hours if you have pain.
• Narcotics are not dispensed for pain from postsurgical ingrown toenail procedures; if your pain is excessive, please go to the emergency room.

Getting Back to Normal

Once your podiatrist has given you the ‘go ahead,’ you can return to regular activities. However, now that you’ve experienced the effects of a painful foot condition it’s not something you want to go through again, not if you can help it. Respect for your feet and the support, balance, and strength they provide your body is a good place to start.

Focus on the proper care and grooming of your feet. Check out our very detailed video: Caution: Pedicures Can Be Harmful to Your Health. Make the appropriate shoe choices for your foot’s structure (high arches, flat feet, etc.), learn to lace your sneakers for proper support, and choose the right socks for healthy feet. Strengthen your feet with flexibility exercises.

Elizabeth E. Auger, DM has been a practicing holistic podiatrist in Salt Lake City for nearly two decades, and as an athlete herself, Dr. Auger is especially knowledgeable in the area of sports injuries. She takes all new patients, offering personalized foot care solutions for those with a sedentary lifestyle or in a rehabilitative state, from infants to senior citizens.

Part B – Ingrown Toenail Surgery Basics

In Part A of this series, we introduced you to the Anatomy of an Ingrown Toenail. Now you have a better awareness of what an ingrown toenail consists of, the way it manifests, some cautionary warnings, and a few trial home remedies as well. You’ve soaked your foot, worn toeless shoes, and resisted the urge to cut the offending nail.

But now you recognize that something’s just not right, and the pain is getting worse. You’re having secondary symptoms: bleeding, skin overgrowth, green or yellow pus draining from the lesion, a foul odor (we call it malodor), and maybe redness creeping up your toe.

It’s time for the next step!

Ingrown Toenail Surgery

First and foremost, if you have symptoms of an ingrown toenail and you also have:

• diabetes, lupus, rheumatoid arthritis, or other autoimmune diseases;
• circulatory affliction such as high blood pressure, atherosclerosis, thrombotic disorders, or cardiovascular disease;

Do not pass Go, do not collect $200 – head straight to a podiatrist!

Surgery for an Ingrown toenail is actually accomplished with an in-office procedure – so there’s no need to take days off work, get assistance with transportation, arrange babysitters, and book dog walkers. You can make your appointment over your lunch break and return to work after you leave the doctor’s office. You will be given care instructions to follow over the next few weeks, then instructed to return for a final checkup. What’s not to love about that?

Place the phone call now and make the appointment as soon as possible, with a podiatrist, before the condition worsens. One visit, that’s what you want – not antibiotics first and a procedure down the road. A matrixectomy is the all-in-one process which removes the offending nail border, cleans out any abscess underneath the nail fold, with phenol applied to dissolve the nail root to prevent its regrowth.

What You’re Worried About

1. The shot – There are 4 nerves in the big toe that must be numbed prior to the procedure. The injection takes less than a minute, and you won’t feel anything after that. As Dr. Elizabeth Auger says, “It’s a little bit of pain and a whole lot of comfort afterward.”
2. Losing a whole nail – That’s not going to happen. Instead, the matrixectomy procedure gets to ‘the root of the matter,’ by curettage of the nail groove and matrix cavity, not the nail plate.
3. Pain after surgery – After a 30-minute procedure in the podiatrist’s office, there is an immediate decrease in pain; the toe will be numb for the first few hours. Any further pain is easily controlled with Ibuprofen 600mg per 8 hours as needed, and by applying an ice pack.
4. Pregnancy – If you are pregnant you absolutely want to have this procedure rather than having an increasingly serious infection going on in your body. Neither the shot nor the phenol applied by a podiatrist will be harmful for you.

What Surgery Will Do for You

Your toe will heal up nicely. The swelling, redness, and pain will alleviate. Draining will cease as the infection is interrupted, and your pain will come to an end. Wearing socks and shoes will feel normal again, and comfortable.

Instead of constant worry and painful episodes, you can focus on properly caring for and grooming your feet, choosing appropriate shoes (and lacing techniques) for your activities and foot structure, flexibility exercises and healthy eating habits (see Part C – Post-Surgical Care of Ingrown Toenails).

Elizabeth E. Auger, DM has been a practicing holistic podiatrist in Salt Lake City for nearly two decades, and as an athlete herself, Dr. Auger is especially knowledgeable in the area of sports injuries. She takes all new patients, offering personalized foot care solutions for those with a sedentary lifestyle or in a rehabilitative state, from infants to senior citizens.

Part A – Anatomy of an Ingrown Toenail

Of the various afflictions, your toes may endure, an ingrown toenail may seem to be in the lesser category — unless it is ignored. There are a few home remedies to try, but if symptoms of redness, swelling, and P-A-I-N persist then infection, disease and even sepsis can occur. The good news is: if you’re suffering from an out of control ingrown toenail, one quick and effective office procedure will do the trick. Honestly.

Let’s take a look at the ingrown toenail, and the way it reveals itself. The condition isn’t as much of a mystery when you understand a little more about the composition and function of your toenails.

Anatomical Structure

The nail plate is a protective outgrowth from the proximal nail fold (and cushioned by the cuticle as it grows out from the nail root). As the nail plate extends to the outer tip (distal fold), it is bordered on either side by the paronychium (lateral nail folds). The nail plate rests on top of the nail bed and protects the nail matrix beneath it, which contains the nerves and blood vessels and is where new nail cells are produced.

The visible part of the nail matrix is called the lunula which contains active nuclei cells — appearing as a white half-moon shaped arc — and sits below the nail plate; becoming translucent as the cells push the nail plate forward. The cells appear pink in color at this point because they are back-lit by the nail bed capillaries below them. The lunula has a unique microscopic anatomy which can be an important determinate of disease.

Anatomical Context 

Though ingrown toenails can be classified in terms of congenital or acquired causes, their appearance is generally the result of wearing ill-fitting shoes, failing to lace your sneakers for maximum support, improper grooming, inappropriate pedicures, or stubbing your toes. Athletes are especially susceptible, as are older persons with thick or curved toenails.

The ingrown toenail manifests itself when the skin on either side of the nail (paronychium) grows over the edge of the nail plate. The skin adjacent to the nail plate will become hardened, tender, swollen and even painful.

Conversely, an ingrown toenail can also present when the nail plate burrows into the paronychium. This sets off a cascade of foreign body intrusion, inflammation, infective and curative processes. A painful discharge may follow, with a foul odor (malodor) emanating from the lesion.

Cautionary Symptoms

For patients with arterial insufficiency or an autoimmune disease such as diabetes or rheumatoid arthritis, an ingrown toenail may lead to severe complications. Septic shock can occur if left untreated, and patients with chronic conditions can also run the risk of losing a limb.

Toenails can be an overall important diagnostic tool. Vitamin deficiency, fungal infections, problematical circulation as well as autoimmune morbidities can be visible from examining the toenail.

Home Remedy Trial

As the ingrown toenail first presents as swollen, red, and somewhat painful you can try this remedy at home. Soak your foot in warm water three or four times a day for 15 minutes, finishing up with a topical antibiotic cream. Try letting the toenail grow out, do not cut it.

If the condition advances and the nail enters the paronychium border, symptoms can now increase to consistent pain, skin overgrowth, bleeding, and oozing of green or yellow pus. These signs definitely suggest that it’s time to seek medical attention from your local podiatrist!

Elizabeth E. Auger, DM has been a practicing holistic podiatrist in Salt Lake City for nearly two decades, and as an athlete herself, Dr. Auger is especially knowledgeable in the area of sports injuries. She takes all new patients, offering personalized foot care solutions for those with a sedentary lifestyle or in a rehabilitative state, from infants to senior citizens.

If you have ever had an ingrown toenail, you know what pain is. Every step you take can be excruciating as the top of your shoe presses against your toe. Ingrown toenails are not only painful, they can quickly become a medical problem that can’t be ignored.

What is an ingrown toenail and who is at risk?

An ingrown toenail is a nail that has grown into the skin. A normally growing toenail grows over the skin. Ingrown toenails are most common in adults with thick or curved nails. The corners of the nail, and eventually the outer edges, grow down into the skin instead of over it.

Are there specific things that cause an ingrown toenail?

There are a number of things that can lead to an ingrown toenail, many of which are avoidable. Rounding the edge of the toenail while clipping instead of cutting straight across is one of the main culprits, as is cutting the nail too short. Shoes or socks that don’t fit correctly can also cause  an ingrown nail.

Repeated activities can also cause a nail to grow into the skin. Things like playing soccer and kicking the ball regularly, hiking in shoes that don’t fit well and even working on your feet in the wrong footwear can all cause ingrown toenails.

Symptoms

The obvious symptom of an ingrown toenail is pain. If the nail gets infected, the skin surrounding the area may swell and turn red. The area may also begin to leak pus if the infection is left untended.

How Ingrown Toenails are Treated

Many people attempt to clip out the part of the toenail that is growing into the skin, but this could be a mistake, only serving to make things worse. Allowing the nail to grow out naturally is the best home remedy. Soak the affected toe in warm water for 15 minutes or more up to three times daily. Wedge a small piece of gauze or cotton under the corner of the ingrown nail. This helps the nail grow out over the skin.

These treatments should continue until the nail has grown out. While you are treating your ingrown toenail, be sure to wear comfortable shoes. If you are able to, opt for sandals that leave the toes exposed, removing any chance of pressure from being applied to the top of the toes.

If the toe does not begin to feel better after three days of home treatment, visit an experienced podiatrist. This specialist will be able to remove the nail in the appropriate manner and offer you treatments that may include antibiotics and pain medication. If, at any time, you believe that your ingrown toenail may have caused an infection, do not attempt home remedies – a visit to the doctor is called for.

If you are suffering with an ingrown toenail in Salt Lake City and need medical attention, reach out to Dr. Elizabeth Auger to schedule an appointment. Dr. Auger will evaluate your toe and provide you with the appropriate treatment options.

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