Ingrown Toenails

Surgical Removal of a Painful Toenail

Dr. Campitelli No Comments

Suffering from a severely painful toenail that is constantly irritated with shoes and impossible to cut?  Surgical removal is most likely the best option.  Toenail deformities can be the result of trauma to the nail plate which can occur from dropping something on your toe, or simply through years of irritation of the nail plate on a shoe.  Nail fungus can also be the cause of a deformed toenail, so it is imperative to first have the nail tested for fungus before making any decisions to permanently remove the toenail.

Many patients ask if it is possible to temporarily remove the toenail and let it grow back.  While this option may seem possible, if the nail has sustained permanent damage through trauma, then it will grow back with the same deformity.

The best solution in cases of severely deformed toenails is permanent removal of the nail plate by a procedure known as a chemical matrixectomy. The toe is anesthetized in the office and the nail plate is removed.  A chemical called phenol is placed on the cells that form the toenail creating a burn which prevents the nail from growing back.  Recovery is typically two weeks of wearing a band aid with antibiotic ointment.  Most people return to work the next day and runners can usually begin running within two days. 

This is what a toe will look like after removal of the nail:

 


 

Infected toenail or nail fungus?

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An ingrown toenail is typically the result of the nail plate growing into the adjacent nail fold or skin next to the toenail. The break in the skin allows bacteria to enter and an infection occurs. 

Sometimes a toenail can acquire a bacterial infection under the nail plate itself. Examples of this can be due to a deformed toenail (which could be from nail fungus or trauma to the toe) causing the toenail to become loose and allowing bacteria to collect under the nail plate and eventual form an abscess. The abscess usually occurs in the eponycium or “cutical” area. 

Here is an example of a nail deformity in which the patient presented with severe pain and drainage from the toenail. Under these circumstances the nail needs to be removed to allow the infection to be drained.  An antibiotic is initiated and recovery is usually two weeks. It’s is important to catch this soon as neglect can lead to a bone infection in the toe. 

What is an ingrown toenail?

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An ingrown toenail is when the border or side of your toenail breaks through the skin next to it which eventually leads to a skin infection or cellulitis. The skin becomes swollen, red and painful. Sometimes you will see pus draining from underneath the nail. 

Treatment at home consists of soaking the foot or toe in warm water and a tablespoon of Epsom salts or antibacterial soap twice a day for fifteen minutes. The area should be covered with a bandaid and antibiotic ointment at all times. 

If home therapy doesn’t resolve the infection the border will need to be removed surgically. This is a simple procedure performed in the office with local anesthesia to numb the toe. Recovery involves soaking for 7-10 days and wearing a bandaid and antibiotic ointment. 

More serious cases may require taking oral antibiotics and sometimes the entire nail needs to be removed temporarily. 

If it is a recurrent situation where the nail continues to become ingrown every six months or more, then a permanent procedure is performed to prevent regrowth of the nail border. 

Here’s a video of Dr. Campitelli performing the procedure in the office. 

SUBUNGUAL HEMATOMAS (RUNNER’S NAIL)

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Subungual hematomas frequently occur in distance runners and I tend to see a lot of them in my practice. While it can be a controversial topic in regard to either draining or removing the entire nail, I learned early in my career that it is best to remove the entire nail.
Read one of my posts on Dr. Nicks Running Blog that gives a detailed approach on the benefits of removing a painful toenail to relieve the pressure from bleeding. 

Surgical removal of ingrown toenail. 

Dr. Campitelli 2 comments

Suffering from an infected ingrown toenail?

There are two possible solutions for your problem. If this is the first time you are experiencing an ingrown toenail, then a nail avulsion would be indicated. This is a surgical procedure performed in the office where the ingrown border of the nail plate is surgically excised. Antibiotics are typically not needed and the condition resolves by simply removing the ingrown nail border. The recovery period is usually 7-10 days and heavy activity such as running can be performed within 24-48 hours.

CAUTION:  THE FOLLOWING VIDEO CONTAINS REAL SURGICAL FOOTAGE

For recurrent cases of ingrown toenails, a permanent procedure is typically chosen. This involves the same technique as a nail avulsion, but a chemical is introduced into the nail groove and the nail matrix (cells that form the nail) is ablated to prevent the border of the nail from growing back.  The recovery period is slightly extended for this procedure as drainage usually occurs for 14 days. Regular activity, as well as exercise,  can again take place in 24-48 hours.

Questions?  Post in the comments section below!

 

Ingrown Toenails: Example of the infamous “hidden” nail.

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If you ever had an ingrown toenail that never responded to your “bathroom” surgery then you may want to read this to see why.

Typically when the nail plate irritates the surrounding nail fold, it breaks the king and gets covered by the inflamed nail fold.  When one tries to “cut the corner” out, they typically miss the entire side and cut a portion of the nail and apply pressure to pull it out.  A spike of nail is left behind and continues to grow and eventually is stuck into the nail fold which complicates the situation even further.  Now bacteria is enabled to enter the skin and an infection occurs.  When this occurs, the only way to remove the nail is through surgical excision and excising the entire side of the nail.

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Topical Nail Solution to soften and clear discolored toenails.
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