Ingrown toenail treatment

Ingrown toenails can be caused by abnormal nail structure, irritation and pressure from ill-fitting shoes, and most commonly improper nail trimming where the corners of the toenails are rounded. Once the nail begins to grow into the skin, the body will begin to treat the nail as a foreign object, causing pain and redness in the soft tissue on the side of the nail. If left untreated, the ingrown toenail can begin to cut into the skin, which can lead to infection of the skin tissue with oozing or granuloma formation. (The granuloma is tissue around the ingrown toenail that is red, moist, and enlarged.)

Non-surgical treatment: If the ingrown toenail is at the end of the toe, a simple procedure called a partial wedge resection (also called a tilt-back procedure) can be performed. This is done by using a nail clipper in a slanted approach to cut the affected part of the nail. Routine subsequent proper nail trimming after a partial wedge resection can prevent the ingrown toenail from recurring in most cases.

Surgical – In most cases, simply removing a wedge from the tip of the nail does not completely solve the problem, especially if the toenail is deeply embedded in the skin.

Surgical procedures for the treatment of ingrown toenails are performed in the office. With the exception of the injection to administer the local anesthetic, there should be no pain during the procedure. There are two main ways to surgically remove the nail. The first is a total or partial removal of the nail. In this case, the nail will grow back over the course of the next 9 to 12 months. In most cases, as long as the causative factor (eg, improper nail trimming or tight shoes) is avoided, the ingrown toenail should not recur.

The second method is a partial or total chemical matrixectomy. With this method, a part of the nail or the entire nail can be permanently removed. The nail matrix is ​​a thin layer of tissue below the nail fold that produces a new nail; when this tissue is removed, the nail no longer grows.

Nail Avulsion: In this procedure, the root of the nail, known as the matrix and found beneath the cuticles, is left alone. This will allow the nail to grow back completely. This procedure requires a local injection to numb the toe, a specially designed nail clipper to separate the nail from the nail bed, and a small tweezer to remove the nail.

Local injection: Local anesthetic is injected into the toe to numb the area around the nail. The injection is not made at the site of the ingrown toenail, but at the base of the toe. Most patients describe the injection as a burning and stretching sensation.

Nail Removal: Once the toe is adequately numbed, the nail’s attachment to the soft tissue and cuticle is released. The part of the nail to be removed is then separated from the nail plate using a blade and nail clippers. This is followed by removal of the nail with fine forceps. Antibacterial cream is applied to the area and the toe is bandaged. It can take 8-10 months for the toenail to grow back to its original length.

Partial Chemical Matricectomy/Total Chemical Matricectomy: In this procedure, the matrix/root of the nail is chemically removed using phenol or sodium hydroxide. This prevents the nail from growing back. Local anesthetic injection is performed using the same technique as in the nail avulsion procedure described above.

After the toe is properly numbed, a tourniquet is applied around the toe to prevent blood flow to the area. Preventing blood flow prevents dilution of the sodium hydroxide or phenol solution and keeps the chemicals strong enough to adequately destroy the nail root/matrix.

Nail removal: When a “partial” chemical matrixectomy is performed, a scalpel and nail clippers are used to cut a portion of the nail. The blade and clipper are applied to the end of the nail and gently pushed down across the nail plate to the cuticle. A fine-jawed forceps is used to remove the part of the ingrown toenail. Up to this point in the procedure everything is the same as nail avulsion. Next, a Q-tip with phenol or sodium hydroxide is inserted deep into the area and under the cuticle to kill the nail root. This procedure destroys the nail root on the side of the nail that grew out and allows the remaining nail to grow as normal.

If a “total” chemical matrixectomy is performed, the entire nail will be removed and phenol or sodium hydroxide will be applied to the entire area below the cuticle. In this case, the entire nail will not grow back.

Surgical Precautions and Complications: It is possible for all or part of the ingrown toenail that was treated with the chemical to grow back. Since a chemical matrixectomy is a chemical burn, this procedure will cause mild drainage during the healing process. This procedure creates a burn that is not suitable for patients who have poor healing or poor blood flow.

Postoperative Management: Between the time of the surgical procedure and the next appointment, Amerigel should be applied to the wound to aid in the healing process. While this wound is healing, it is expected that you will have mild drainage from the area with mild redness and swelling. Also, there may be some pain, which can be relieved with pain relievers such as Tylenol. Typically, after surgical removal of an ingrown toenail, a follow-up appointment is scheduled to perform proper wound care at the surgical site and to monitor the outcome of the ingrown toenail removal.

Copyright (c) 2010 Bruce Lashley