A Step Ahead: Painful Toenail? It Might Be ingrown.
by Ralph J. Napolitano, Jr., DPM, CWSP, FACFAS
The number of steps an average person takes in a lifetime equal walking our planet about four times. That’s a lot of steps. And if your feet hurt, that’s a lot of painful steps. The obvious challenge for patient and doctor alike when it comes to treating a foot problem is simply resting that ailing foot. And if both feet are problematic, that’s an even trickier problem to solve when it comes to rest. Even the seemingly smallest of foot problems can cause some big-time grief. Example: Ingrown toenails. A very common foot problem that can affect anyone, young or old. Even infants may be seen with this problem.
When toenails “in grow,” they curve and pierce the skin on one or both sides of the affected toe resulting in significant pain and almost always infection. The big toe is by far the most common toe in which this occurs, but the smaller (or lesser) toes can develop ingrown toenails as well.
Toenails may in grow at the end or “tuft” portion of a toe instead of the toe borders, but this is rare. So what causes ingrown toenails? Lots of things such as trauma, incorrect toenail trimming, poorly fitting shoe gear and genetics.
When it comes to treating ingrown toenails, prevention plays a big role. Avoid ill-fitting shoes, especially shoes that are tight in the toe box, and incorrect toenail trimming. Correct toenail trimming means trimming not too short and more straight across versus excessive rounding. And please avoid “bathroom” surgery. I see patients all the time that have tried valiantly, but unsuccessfully, to remove their own ingrown toenails. Professional treatment involves removing the offending toenail border surgically and treating infection when present which is almost always.
This procedure is commonly done in the office setting under simple local anesthesia. Patients walk in and walk out. Recovery is fairly simple and requires limiting strenuous activities for a couple days, wound care while the surgery site heals and treating infection with antibiotics. Most patients are completely pain free in about a week. Modern techniques involve destroying the “root” of the ingrowing portion of the toenail preventing recurrence in about 95% of cases. And when done correctly, the toenail looks completely normal once healed. No pain, all gain.
-One to grow on…
Dr. Napolitano is a double board-certified podiatrist and wound care specialist physician. (CWSP). He specializes in medicine, surgery and wound care of the foot, ankle and lower leg. He was the first podiatrist in the state of Ohio to earn the board certification Certified Wound Specialist Physician (CWSP).