Podiatry Courses
podiatry courses
Treatment of ingrown toenails
Copyright (c) 2010 Bruce Lashley
Ingrown toenails can be caused by the abnormal structure of nails, irritation and pressure from poorly fitting shoes, and most often by poor nail cutting where the corners of the toenails are rounded. Once the nail begins to develop in the skin, the body begins to treat the nails as a foreign language subject, which causes pain and redness in the soft tissue side of the nail. If left untreated, ingrown toenails may begin to cut into the skin, which can lead to an infection of the skin tissue with oozing or granuloma formation. (Granuloma is a tissue around the ingrown toenail is red, moist, and the increase size.)
Non-surgical treatment: If the ingrown toenail is at the end of the toe, a simple procedure called partial resection wedge (also called a backup oblique) may be performed. This is achieved using a nail clipper in an oblique approach to cut the offending part of the nail. A good cut and polish after routine after a wedge resection can prevent partial ingrown toenails from recurring in most cases.
Surgical: In most cases, simply removing a corner of the nail to the tip does not completely solve the problem, especially if the nail is firmly rooted in the skin.
Surgical procedures to treat ingrown toenails are performed in the office. Except for the injection of local anesthetic delivery, there should be no pain during the procedure. There are two main ways to remove the nail surgically. The first is a withdrawal or partial varnish. In this case, the nail will grow back over the 9 to Next 12 months. In most cases, as long as the factor that causes (eg cutting nails improper or tight shoes) is avoided, the nail flesh should not be repeated.
The second method is a chemical matrixectomy partial or total. With this method, a portion of the nail or entire nail can be removed permanently. The nail matrix is a thin layer of tissue under the nail fold produces new nails when this tissue is removed the nail is not growing.
Nail avulsion: In this procedure, the root of the nail, known as matrix and are under the cuticle is left alone. This will allow the nail to extend completely. This procedure requires a local injection to numb the tip, nail separator specially designed to separate the nail from the nail bed, and a small clip to remove the nail.
The injection Local: A local anesthetic is injected into the toe to numb the area around the nail. The injection is not performed the location of the ingrown toenail, but is injected at the base of the toe. Most patients describe the sensation as an injection burning and stretching.
Nail Removal: Once the big toe is numb enough, the attachment of the nail tissue soft cuticle and is released. The portion of nail is then poured out of the nail plate with a blade and separator polish. It is followed by the removal of the nail with a fine forceps. antibacterial cream is applied to the region and the toe is dressed with bandages. It may take the nail from about 8 to 10 months to push to its original length.
Partial chemical Matrixectomy / Total chemicals Matrixectomy: In this procedure, the root of the nail-matrix is removed chemically using either phenol or sodium hydroxide. This prevents the nail regrow. The local anesthetic injection is performed using the same technique as in the above procedure described avulsion of the nail.
After the big toe is numb enough, a tourniquet is applied around the toe to prevent blood flow in the region. Prevents blood flow prevents diluting the sodium hydroxide or phenol and maintains chemicals strong enough to destroy the very root of the nail / Matrix.
Nail Removal: When you perform a "partial" chemical matrixectomy a splitter blade and is used for cutting nails part of the nail. The blade and the splitter nails are applied at the end of the nail and gently pushed down by the nail plate the cuticle. Fine forceps jaw is used to remove the part of the ingrown toenail. Up to this stage of the procedure is still as shown in nail avulsion. According to a Q-tip with phenol or sodium hydroxide is inserted into the deep zone and under the cuticle, to kill the root of the nails. This procedure destroys the root of the nail on the side of the toenail and the nail can still develop as usual.
If a matrixectomy "total" chemical is produced, the entire nail is removed and sodium hydroxide or phenol is applied the entire area under the cuticle. In this case, the entire nail will not grow back.
Precautions and surgical complications: It is possible that some or all the ingrown toenail that was treated with the chemical can regrow. Since a chemical matrixectomy is a chemical burn, this procedure cause a slight discharge during the healing process. This procedure creates a burn that is not appropriate for patients who have poor wound healing or poor circulation blood.
Post-Op Management: Between the time of surgery and the next appointment, Amerigel should be applied to the wound to help the healing process. Although this injury is healing, it is expected to have low drainage area with a slight redness and swelling. In addition, there may be some pain, which can be relieved by pain medications such as Tylenol. Generally, after surgical removal an ingrown toenail, a next appointment is scheduled to perform wound care specific to surgical site and monitoring the results of removing ingrown toenails.
About the Author
Bruce Lashley, DPM
Dr. Lashley is a podiatrist practicing in midtown Manhattan for the past 27 years. He specializes in the conservative and surgical management of the foot. In October 2009, Dr Lashley moved his office to a new modern facility at 353 Lexington Avenue, in NYC. For more information on Dr. Lashley visit his web site.
Podiatrist in Brooklyn, NY – Michael Perlstein, DPM
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