Description

Ingrown toenails occur when the edge of the nail is pressing against the skin of a toe. This can happen to one or several nails. It is more common on the feet then hands. This can be associated with infections if the nail has pierced the skin allowing for bacteria to infiltrate.

Causes

Previous trauma is one way the nail can shift into the skin and then keep growing. Others causes include a wide nail matrix (cells that grow the nail) that will continue to push along the skin.

Symptoms

Pain is the most common complaint of ingrown toenails, especially in improper fitting shoes that push upon the toe. Infection may also occur which will increase pain and swelling.

Treatment

The management of ingrown toenail is to cut away the nail that is impacting the skin. There are several management options including removing the whole nail or just the offending edge. The nail matrix can also be removed and chemically destroyed to greatly reduce the chance of recurrence.

1. How is a nail excision performed?
   First your toe will be injected locally with a common anesthetic known as lidocaine. This is similar to what you may have received when have dental work performed in the past. This provides pain management during and after the procedure for 2-4 hours. When the area is numb, either strip of nail along the edge or the entire nail will be excised according to previous discussions. Any infection is surgically drained. This procedure typically takes approximately 20-30 minutes in the office. A sterile dressing will be applied to the toe after the procedure. You will be given prophylactic antibiotics after the procedure for 3 days to minimize the risk of infection. You may also receive some pain medication depending on the extent of the procedure.
2. What is the typical recovery time for nail excisions?
   Following a nail excision, you will have an antibiotic dressing applied to the toe in our office. This dressing needs to stay dry until we see you back in follow-up typically 3-4 days following the excision. At this time, we will change the dressing for the first time. We will assess for any infection, clean the toe and apply a new sterile dressing. At this time we will instruct you on how to care for your toe including how to wash it and keep it clean. With our permission, you can then beginning washing your toe every day with soap and water. DO NOT SOAK YOUR TOE. Running water is ok after the procedure but we do not want your toe to be soaking in water for risk of infection. You will see us in follow-up one more time approximately 1 weeks after the initial follow-up for assessment. It takes approximately 2-4 weeks for your toe to dry up after the procedure. It is ok to wear normal shoe wear after the procedure with a dressing on the toe to protect it from rubbing. After the would dries, you can return to regular activities. Below is a typically recovery from a complete nail excision performed with phenolization.