Ingrown Toenail Surgery
Not all cases of ingrown toenails require surgery, yet some do. Why is this such a problem that surgical intervention is sometimes needed? Let’s start by looking at ingrown toenail symptoms and how they can make life miserable.
How Ingrown Toenails HappenWhen a toenail becomes ingrown, the side or corner of the nail starts to grow into the soft flesh flanking it, instead of over the top (as it’s supposed to). As you probably understand, something “growing into flesh” is going to be a problem. In this case, the ingrown nail can cause symptoms like pain, swelling, and an increased risk for infection. Being able to identify an ingrown toenail is your first line of defense in preventing painful symptoms and hopefully not needing to clear up complications later down the road. Whereas this condition can technically happen to any of the toes, it most commonly develops with the nail of a big toe. Men and women of all ages—from 2-month-old infants to those who’ve managed to cross the century barrier—can all potentially develop an ingrown toenail (if they have toes and nails). In addition to the previously mentioned pain and swelling, there are times when a patient will notice pus at the site of the ingrowing or a redness that spreads. These are potential signs of infection and you need to contact us ASAP. (If you are diabetic, don’t call us – go right to the emergency room!) Infection and severe pain are both signs that you need professional care in short order. Okay, those are the signs and symptoms you need to know, but why does this problem even happen? There are a handful of reasons why toenails become ingrown, including:
- Inherited structure – Nails that are unusually curved are more likely to become ingrown than those featuring a more typical shape. Out of the various causes of ingrown toenails, this is the biggest one.
- Physical trauma – The second-biggest cause of ingrown nails is physical trauma from dropping something heavy onto a foot, accidentally (we hope!) kicking a wall or solid object, or sports injuries. As if the ingrown toenail isn’t bad enough, this can also increase your risk for a fungal nail infection (since fungus now has an entryway into a warm, protected environment).
- Improper nail trimming – Patients who trim their nails too short or round them off have a higher rate of ingrown toenail occurrence than do those who clop them straight and keep the nails even with the edges of their toes.
- Ill-fitting footwear – Shoes that fit poorly create or contribute to a host of issues, including this one. Footwear that is too tight crowd the toes together, which makes it more likely that ingrowing will take place.
Treating Ingrown ToenailsWhen it comes to treating a mild-to-moderate ingrown nail, the first steps might be to try soaking the foot and then gently lifting the nail into a more natural position. You may want to try this at home – as long as you are not diabetic. Remember, if you have diabetes, you need professional care for any issue that arises. Unfortunately, it isn’t always that easy and such methods don’t always remedy the situation. At that time, we should explore more aggressive options, including either partial or complete removal of the affected nail. Partial nail removal is beneficial for severe ingrown nails that are causing intense pain or have become infected. In this instance, we will remove the ingrown portion of your toenail after numbing the toe with an anesthetic. If the issue returns repeatedly, we will likely need to move onto the final stage of treatment – complete removal. In a complete removal procedure, we may need to take measures to ensure that the nail doesn’t grow back. This can be achieved by performing a matrixectomy on the affected toenail. This inhibits the toenail’s matrix from generating new nail tissue. Generally speaking, the determining factors as to whether we recommend toenail removal are the severity of the condition and whether or not it is recurrent. Between the two issues, it’s more likely we recommend surgery to resolve a recurrent case. The reason for this is simply that the unusually curved structure will cause the nail to continually become ingrown. Instead of allowing the problem to repeat itself over and over, we just nip it in the bud. As with any kind of surgical procedure, it’s a good idea for you to understand what you’re signing up for (so you can be prepared and know what to expect). The procedure to remove your toenail is quick and simple. It’s done on an outpatient basis under a local anesthetic, which means you should be prepared to have someone drive you to and from your appointment. You may also need a tetanus shot if it has been more than 5 years since your last one. This is because, as noted, infection risk tends to be very high with an open wound. In the event an infection is already present, we will drain any fluid or pus prior to removing the portion or complete toenail so you can heal completely. After your surgery, the nail will be covered with antibacterial ointment and gauze. It is very important to follow all our post-operative instructions, including how to keep the wound clean. This is just because we want you to be safe! Be aware that you will probably be able to put pressure on your foot, but it may be uncomfortable for a bit. This is something that will go away in a couple of days. Any operation presents its own unique set of potential risks, so make sure you keep an eye on things and contact us as soon as you can if you become aware of any issues. Sometimes, it is difficult or even impossible to prevent a toenail from becoming ingrown. As noted, this condition can happen because of an inherited nail or toe structure, and there’s really no way to prevent that.
Preventing Ingrown ToenailsAt other times, though, there are measures you can take to reduce your risk of an ingrown toenail. With that in mind, here are some ingrown toenail prevention tips:
- Clip your toenails properly. As a rule of thumb, keep your nails roughly even with the edge of their respective toes. If they are too short, it increases the likelihood for becoming ingrown. Also, it is easy to think toenails should be rounded off—since this is what we do with our fingernails (when keeping them short)—but it is better practice to cut them straight across.
- Wear shoes that actually fit. Although it isn’t necessarily a leading cause of ingrown nails, some cases do happen or are made worse because of tight footwear. The problem in these instances are toe boxes that squash toes together. This can press the surrounding skin against the nails and cause them to grow into it. Shoes that are too small or tight in the toe box area can cause other problems as well, so always make sure your toes can wiggle freely in your footwear.
- Protect your feet. There are additional benefits to doing so—decreased risk for fungal toenails to develop and, obviously, less pain—but one way to potentially prevent ingrown nails is to wear safety shoes or steel-toed work boots if your job entails heavy objects on a frequent basis. Of course, many employers will require this anyhow.
- Ask for help. If you don’t work at a job or engage in hobbies featuring heavy objects, there probably isn’t much need to own steel-toed footwear. This means that if you are moving furniture, full boxes, or anything else around the house or garage that is heavy, you should ask for help.
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