Ingrown toenails are commonly treated in our office. An ingrown toenail is caused when the nail grows/cuts into the side of the skin at the nail border, creating an opening for bacteria to enter. Often times, this becomes infected with a reddish and swollen appearance along the nail border. Sometimes, there is oozing and formation of extra skin, as the area tries to heal itself. Oftentimes, patients present to our office with this condition, having cut their toenails too short or having worn shoes that are either too tight, too narrow, or have worn heels that caused the toes to move forward into the narrow part of the shoe pinching the toes together. Sometimes, patients are genetically predisposed to ingrown nails.
At our office, we often take x-rays of the toe, which may reveal a bone spur/calcium deposit. The toe bone may be enlarged pushing into the side of the nail. Sometime, a bone spur may be growing at the tip of the big toe under the toenail plate and projecting upwards. This causes the toenail to grow upwards increasing the curvature of the toenail at the sides, where it may dig into the skin causing problems.
After x-rays are reviewed, we numb the toe and with special precise instrumentation and remove a small border of the ingrown nail. This usually allows the nail to grow back more normally. Should we find that a bone spur is present, we will file the bone spur down to prevent the recurrence of the ingrown nail. In addition, we often use acid medication (phenol) to kill the nail root along the edge of the toenail to prevent further regrowth.
For a bone spur which is present along the bony top surface of the tip of the toe, we will file and/or remove the bone spur. Sometimes, a small skin plasty is necessary to bring the skin at the end of the toe downward to allow the nail plate to go grow flatter as it grows outward.
Although ingrown toenails most commonly occur to the big toe, they may also occur to the smaller toes. In addition, our office advises our athletic patients to trim their toenails mildly shorter to prevent the tips of the toes from rubbing into their shoes causing bloody toenails. Nail edges should be rounded and smooth so there is less chance of cutting into the adjacent skin. Should you have any concerns with any toenail issues, please do not hesitate to schedule an appointment at our office for expert care.
Written by Richard T. Braver, DPM, FACFAS