Ingrown toenail (Onychocryptosis) can be a chronic problem with some people and even families. Ingrown nails are often inherited, as the trait controlling the structure of a nail is passed on. For some, the condition can be acquired from an injury, foot type, or an infection of the nail.
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Anatomy of a Nail
Ingrown toenails occurs when the nail becomes stuck in the skin adjacent to the nail called the nail fold. As the nail continues to grow it creates pressure – causing inflammation and potentially an open wound and infection. If a sore opens as the nail is growing, infections and abscesses can be common and very painful. Occasionally, an infected ingrown toenail will develop proud flesh or a pyogenic granuloma. A pyogenic granuloma is a vascular mass that is beefy red, sensitive to the touch, and bleeds profusely when injured.
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Ingrown Nail with Pyogenic Granuloma

 

Treatment of Ingrown Nails

In some people it is possible to reduce the risk of ingrown toenails by cutting the toenails in a particular way. In others it is almost impossible to prevent ingrown toenails without surgically removing a portion of the nail.  A wedge resection or slant back of the nail border can be done as a temporary fix. The wedge resection is done by removing a section of the nail from the nail border at a steep angle making sure that all of the nail is removed. It is very difficult for the average person to perform this procedure correctly with standard nail nippers.

Surgery for Ingrown Nails

  1. For most people that have severe ingrown nails they are difficult to trim and surgical intervention is required. Recurrent infections and pain with some episodes more severe than others require removing a portion of or the entire nail. Here is some criteria to consider before making a decision on how much nail to take.

    1. Is the nail otherwise healthy?
    2. Is the nail ingrown on both sides?
    3. How long is there between the ingrown nails?
    4. What is the general shape of the nail?
    5. How deep does the nail grow into the borders.
    6. Is the toe causing an increase in pressure along the nail fold.

    The problem can be fixed permanently (matrixectomy) or temporarily (avulsion) As a podiatrist with more than a decade of experience, it is difficult justifying a temporary procedure unless there is a severe infection around the ingrown nail or this was the first time. In these cases it can be beneficial to perform a partial or complete avulsion.

    The matrixectomy either partial or complete is a permanent solution to the problem. The most common and least intrusive way of performing this procedure is by removing the problematic nail and killing it with a medication applied to the root of the nail. The medication destroys the root of the nail, so there is no more nail growth in that area.

    For both the avulsion and matrixectomy post operative care is very similar.  You are able to walk immediately after the procedure but the patient is required to keep the area clean and covered. Soaking and dressings for the wound after the procedure are mandatory, but the times do vary depending on the circumstances prior to the procedure.