When the edges of the nail plate penetrate the skin around the toenail, the nail acts as if it were a foreign body to that skin. Bacteria can invade the site, and sometimes, the body mounts a response to this. A significant infection can ensue, resulting in excruciating pain, redness, puss, and swelling. In patients who have diabetes or poor circulation, this seemingly minor problem can become severe, ending in some cases, with loss of toe or limb.
There are several causes of ingrown toenails: a hereditary shape of the nail plate, trauma - (cutting the nail too short, stepping on toes, etc.), fungus in the nail, and/or improperly fitting shoes. "Bathroom surgery" at home is all too common, only to have the problem recur a few months later as the nail grows out.
There are two main tenants of treatment:
- Resolve the infection
- Permanently remove the ingrown nail
This is done routinely in the office with the help of local anesthetic. The toe is numbed, and the offending border is removed. Next, the nail root is treated with a chemical so that the ingrown margin of nail does not grow back, permanently. A dressing is applied, and the patient is able to resume normal activities the following day. There may be mild discomfort, similar to sunburn. This rarely last more than 1 to 2 days postoperatively. The procedure has an 85-95% success rate. Not all patients are candidates for this procedure. A thorough podiatric history and physical must be performed by the physician prior to treatment.
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