1. Welcome to the Foot Health Forum community where you can ask about foot problems and get help, as well as be up-to-date with the latest foot health information. Only registered members can ask a question, but you do not need to register to respond and give help. Please become part of the community (here) and check out the shop.

Ingrown toenail

Discussion in 'Ask your questions here' started by Podwithaquestion, Jun 30, 2008.


  1. Members do not see these Ads. Sign Up.
    Hello,

    I am a podiatrist in Australia and have been practicing for a few years, i have done many nail surgeries and 99% are successful. However in the last year, I have had two patients (brother and sister) come in for partial nail avulsions, and BOTH of them have returned with an ingrown toenail on the same side same toe.

    The brother who is 18 yrs old, took 12 months to become a problem, however there was a considerable amount of hypergranulation/proud tissue periunually and so that was removed as well as the nail and no problem has ensued.

    However, his sister, about 16 yrs old, has come back in 5 months with the same problem.

    My question is, how long does it take for a nail to grow back and cause a problem?

    We were taught it takes about 10-12 months to completely grow back but I am using phenolization of the matrix and so I expect NO REGROWTH at all of the offending nail.

    Could this just be due to poor/tight footwear or hypergranulation tissue?

    What other options are there?

    Thanks.
     
  2. Unregistered

    Unregistered Guest

    If the phenol comes into contact with blood it is not effective, so this may have happened and it could just be a coincidence that its a brother and sister.

    Have all your nail surgeries come back to you after a year? You could find you have more regrowths than you think, its just they havent presented as a problem 2nd time round.

    It happens to us all!!
     
  3. FootDoc

    FootDoc New Member

    In your post you state that you performed nail "avulsions," which, where I come from indicates only a removal of the nail or nail segment without any attempt to destroy the associated matrix, and I would expect the nail to most always return and generally ingrown again unless the original problem were entirely the result of external forces and these forces were subsequently mitigated.

    Normal nail growth is variable and sporadic, but nails where the matrices have been treated with phenol in an attempt to destroy them but they have been incompletely destroyed may remain dormant for a variable and inordinate amount of time before producing nail again.

    But if you are truly having 99% success with your nail surgeries, I can assure you that you are achieving far better results than most anyone else. With sufficient phenol application you certainly can achieve such a result, but at the trade off, in the case of partial nail destructions, of having the remainder of the nail either also destroyed or more likely made very deformed. It is only a matter of good fortune that one can choose the exact correct degree of phenol application sufficient to destroy only the portion of nail matrix one wishes while leaving the remainder completely unaffected. In my practice, I generally advise patients that such surgery is no more than 75% successful in achieving those results.

    If you have a patient who is repeatedly refractory to ingrown nail surgery by phenolization of the matrix, I would consider one of the many other methods of nail surgery which rely on actual physical excision of the offending portion of matrix
     
    Last edited: Jun 30, 2008
  4. Unregistered

    Unregistered Guest

    Thanks for all your help.

    I think 99% is an exaggeration by myself, but I do usually have a yearly checkup and I'd have to say around 85-90% do not regrow or haven't within the 12 month period.

    I always perform phenolisations not just 'avulsions' just to clear that up.

    I have recently seen the girl and her complaint was not to do with the nail but with an area of hypergranulation tissue that is causing discomfort which will be appropriately treated.

    Once again thanks for your help on this matter.
     
  5. FootDoc

    FootDoc New Member

    I would assume that the granulation tissue was either excised or destroyed by cauterization when the ingrown nail procedure was performed, and its return without a recurrence of the offending portion of nail would seem unlikely.

    This does, however, bring to mind a situation that occurred in my practice, where I had treated an infected ingrown great toe nail with what, in addition, appeared to be either granulation tissue or perhaps a pyogenic granuloma arising from the nail groove. I treated the toe as I normally do, and had the patient soak and dress it and return in 1 week, at which time there was something about this area of concern that caused me to take a biopsy of it. Wounds up that it was a amelanotic melanoma, which, of course, unlikely most melanomata, had not the typical color, and was thus not obvious to detection. I sent her for evaluation to an oncologist who reconfirmed the diagnosis, and we decided to amputate her entire great toe, which likely saved her life. Multi-year followup never showed any metastasis or new lesions. I don't offer this as a likelihood in your case, but simply a caution that mundane-appearing things are not always what they seem to be.
     
    Last edited: Jul 1, 2008
  6. Windbreaker

    Windbreaker New Member

    GOOD ANSWER
     
  7. Michelle96

    Michelle96 Guest

    Hi doc,I would like to ask on what should I do with my ingrown toenails..
    I have it both of my right and left big toe,growing on two sides also..It hurts so much...I'm worried about it..I feel so sad coz it hurts when I run(sometimes),kick.I've removed my nail once,but just half,bcoz it happen on one side only at that time.Does the way of cutting my toenails affected it to happen again?
    -Worried,sad-
    I appreciate it if doc reply my post..Thx
     
  8. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    This takes more explanation than you might have thought:
    An ingrown nail essentially is a nail in which the nail plate is too wide to be accommodated by the lateral space intended for the nail. This causes undue pressure on the internal side of nail lip, generally causing pain. Sometimes this pressure breaks the "skin" of that nail lip allowing the offending nail to puncture the nail lip, often causing an infection. The basic problem of ingrown nails is not one generally caused by improper cutting, but when an ingrown nail sufferer attempts to relieve the pressure and pain of the ingrown nail and improperly attempts to angularly deeply section the offending portion of the nail, leaving a sharp spicule of nail generally at the base of the section, when that nail grows, the sharp section often snags the nail lip and creates an infection as mentioned above. But keep in mind, unless there were an ingrown nail in the first place, he/she would not likely be cutting into the sides of the nail. So cutting of the nails in not generally a cause an ingrown nail, but improper care of that ingrown nail often results in infection. Instead of treating this yourself, see a podiatrist either for ongoing prophylactic or permanent care.
     
    Last edited: Mar 29, 2009
  9. Unregistered

    Unregistered Guest

    I really need advice....I cut my finger nail wrong. I admit, as a result an infection started, I have a roundish cluster of tissue, very tender and swollen, reminds me a bit of a wart i had once, however this is soft and red, and sometimes puss will come out. I looked it up and it really looks like it is a Granuloma.
    I cant go to the doctor right now i am in japan for 2 months. What can i do??
    Will this go away on its own without any medical treatment? I use hydrogen peroxide and Neosporine, along with having it in hot, almost to where i cant stand it then i apply cold.
    It really hurts, and i have a 9 month old that i have to handle.
    I can still move my finger even though i don't really want to...
    I don't think its cancerous because the finger next to it seems to be developing an infection also... but its not bad on that finger. Am I right to think that cause my other finger is showing signs of infection that it is bacteria or viral?
    I hope someone answers me soon.
    Thank you
    Mal.
     
  10. FootDoc

    FootDoc New Member

    Although you posted under an already titled thread for "ingrown toenail," it appears from your description that you have a hand (finger) problem, not a foot (toe) problem. This is a forum for foot problems only. But Japan is a modern country where medical care should be available. I see no reason why you can not seek adequate appropriate medical care there.
     
    Last edited: Jan 28, 2010
  11. Unregistered

    Unregistered Guest

    I have an ingrown toenail, which I have had many of over the past year or so. Every time the cutting procedure is done, I have no complaints, only the usual pain and eventual healing of the surgery. My problem now is that I have another one, but am now on Plavixand aspirin for anothr reason. I am unable to get off those meds for now, as I had heart surgery only 2 weeks ago. Are you aware of any othter treatment that can be done to resolve this problem? Thank you.
     
  12. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***************************************************
    Consult your general physician or whomever prescribed the Plavix and aspirin for advice regarding bleeding risk. Most ingrown nail problems can be treated preemptively with on-going palliative care without surgery, though not permanently, and a skillful podiatrist should be able to do this without bleeding risk providing you are seen at appropriate intervals.
     
    Last edited: Mar 9, 2010
  13. ymclain

    ymclain Guest

    In March 2010, I began having occasional pain at the end of my right great toenail, not at the base but a few millimeters from the the interior edge of the nail end. The pain in not on the surface but feels deep in my toe. This continued to occur over the summer. There was no redness or swelling at anytime. The pain began to occur more frequently and intensely in the fall. Anytime I bumped my toe I experienced excruciating pain. I believed I had an ingrown nail. I visited a podiatrist in the orthopedic group I use. After an examination and the doctor ablated the side of the nail. After a couple of days, the area was red and oozing fluid. A return to the podiatrist resulted in an antibiotic prescription and instruction that the skin next to the nail would take time to heal. After the ten day dose, the inflammation subsided, yet the pain did not. The pain was the same as prior to the original visit. After six weeks, I returned to the podiatrist asking if I might have a spicule. He said he believed all the nail was removed. He then used silver nitrate on the tissue exposed by the ablation. He said the skin had granulated and that this should resolve the pain. Unfortunately, now six weeks later, the pain is still present when my toe is bumped, or pressed at the same spot, the end of the nail corner. Is this common? Do I have a spicule? Could there be some other problem associated with my toe? Thank you for your time and consideration of my ailment.
     
  14. CCSS

    CCSS Guest

    Hello all. I am looking for advice.
    I have constant "pain"/discomfort at the sides of both of my big toes. I end up getting pedicures every 2weeks or more because it relieves the pain for a couple days...however...please know I am aware this is likely what got me into this position to begin with!
    That being said, after 10 years I can't take it anymore. I want to have the daily discomfort eliminated.
    I have never had an infection with puss on either nail, but they are always pink down the sides, and not red. This may be because I have a pedicurist digging out the sides weekly so I can cope.
    I would appreciate recommendations on treatment for permanent relief.
    Thank you for your time!
     
  15. Gman

    Gman New Member

    Hi

    Interesting reading all the comments.
    I have just had both Nails on my large toes removed and after years of discomfort the pain has gone, its the day after and the guys who done this were great, I have one question when should i bathe my feet i have been advised to have the dressings removed in 3 days time and i only had it done on the 3rd of Feb? possibly a very silly question.
     
  16. marymundy

    marymundy New Member

    hi there, did you ever get a reply to your question about you ingrown toenail pain after removal? I have the exact same problem as you describe. horrible!! pls let me know. i am worried. mary
     
Loading...

Share This Page