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Ingrown Toenail

What is an ingrown toenail?

An ingrown toenail is a painful condition when the border or side of the nail puts pressure against the soft tissue next to the nail causing inflammation and often a small infection. An ingrown toenail is referred to as onychocryptosis. An ingrown nail most commonly occurs to the big toe but can occur at any toe.

Symptoms:

  • Pain, swelling and redness to a toe along the nail border
  • Drainage from the area (yellow, white, blood)
  • A fleshy wound along the nail border

Causes:

  • Abnormal curvature of the nail.
  • Shoe gear irritation to the nail border.
  • Trauma
  • Aggressive trimming of the nail.

Diagnosis:

  • Clinical diagnosis is used in determining when an ingrown nail is suspected.
  • An X-ray may be taken to evaluate the shape of the underlying bone, rule out bone cyst or spur or in very rare cases to rule out infection of the bone when long standing infection has been appreciated.

Treatments:

  • Ingrown nails are mostly treated with an in office procedure called a nail avulsion.
  • The severity and location of the ingrowth of the nail will determine if a small portion of the nail is removed or if it is necessary to remove the entire nail.
  • In addition to removing the nail, a procedure can be performed to prevent the nail from growing back. This is called a matrixectomy. This procedure includes using Phenol, an acid, to destroy the matrix or nail growth center.
  • The procedure is performed in the office and most often on the day of the presenting visit.
  • Local anesthesia is used to numb the toe prior to starting the procedure.
  • A compressive dressing is applied after the procedure.
  • Post procedure instructions include daily soaking of the toe and covering the area with an antibiotic ointment and a band aid.
  • Prescription pain medication is rarely prescribed, most patients do well with over the counter ibuprofen or Tylenol.
  • Oral antibiotics are prescribed in the presence of underlying infection.