Ingrown Toenails

Ingrown toenails are due to the penetration of the edges of the nail plate into the soft tissue of the toe. It begins with a painful irritation that often becomes infected. With bacterial invasion, the nail margin becomes red and swollen often demonstrating drainage or pus. In people who have diabetes or poor circulation this relatively minor problem can be become quite severe. In this instance a simple ingrown toenail can result in gangrene of the toe. These patients should seek medical attention at the earliest sign of an ingrown toenail. There are several causes of ingrown toenails: a hereditary tendency to form ingrown toenails, improperly cutting the toenails either too short or cutting into the side of the nail and ill-fitting shoes can cause them. Children will often develop ingrown toenails as a result of pealing or tearing their toenails off instead of trimming them with a nail clipper. Once an ingrown toenail starts, they will often reoccur. Many people perform "bathroom" surgery to cut the nail margin out only to have it reoccur months later as the nail grows out.

Treatment

All ingrown nail procedures can be performed under local anesthesia if there are no contraindications such as allergy. A fast-acting local anesthetic such as xylocaine 1% or 2% is often used, is very tolerable, and any feeling in this area will be slight.

Partial Chemical Matrixectomy

This is performed on patients with CHRONIC ingrown nails or patients who are predisposed to reoccurring ingrown nails. A similar procedure to this is called an incision and drainage; it is also performed on infected ingrown nails. The major difference between the two procedures is the angle that the nail plate is cut and the use of chemical to eliminate the cells that are growing the portion of the nail that is painful.

The procedure should not take more than five minutes and should be completely painless. A portion of your nail will be cut and a Q-tip is inserted with a chemical to eliminate some of the nail growth cells. Alcohol will be used to flush out any remaining chemical, and your toe will be dressed with a sterile bandage.

You will be given home care and soaking instructions, medication, and perhaps an antibiotic. A follow up appointment should be made within the week. The wound will look red and could drain a clear fluid for up to five weeks.

Post Op Tips

• Use a blow dryer at night on the wound to facilitate drying
• Ask for Corti-sporin drops and use them daily.
• If drainage stops after 1-2 days and feels tender, lightly massage with clean hands to stimulate drainage
• Use a large Band-Aid that covers the great toe during the day, remove at night after to first few days to facilitate drying the wound.
• Do not use occlusive ointments; they will block the drainage ports which need to be open