Ingrown Toenails and Nail Removal

Ingrown Toenails:

(aka Paronychias)

Toes with ingrown toenails can become very painful, red, and infected. Can we treat this for you at home? Yes. We'll spare you from having to see pictures of bad infections and keep it simple with the picture of the mild ingrown nail over there on the right of this page.

Why do some people get ingrown toenails and others do not? 

  • There's definitely a genetic component. In residency, Dr. Brown learned about the family tendency to get ingrown toenails when treating multiple young siblings for this issue. 

  • Tight shoes that push the toes tips together can increase the chances of getting an ingrown toenail. 

  • Trauma (or injury) to the toenail can cause mild nail corner pressure to turn into an infected nail corner due to swelling of that area against the nail, from the injury. 

  • The most common cause though, is improper cutting of the nail corners. Cutting the nail corner back and then pulling it out can cause a sharp "right angle" shape to the nail edge that will then get caught and dig into the skin whenever it tries to grow past it. Using professional nail nippers, Dr. Brown can slant-back cut the nail border back (if desired) to remove the painful corner while also making a smooth nail edge there that will be more likely to grow out without problems. 

 

This leads us to the topic of nail removal. ​By removal, it can be permanent or temporary and it can also be a partial nail removal or total

Nail Removal:

Why would anyone want to remove a toenail and what does that entail?

There are 2 main reasons for nail removal, and several different ways to do it. 

  1. The first reason that a client may want to remove a toenail is if the have recurrent ingrowing toenails. 

  2. The second reason is for removal of stubborn fungal toenails. 

With Ingrowing Nails, it usually isn't recommended to completely remove the nail or even to permanently remove it. Commonly the offending nail border is removed, by either gently cutting it back or by numbing the toe with local anesthesia and removing the entire nail border. This is not permanent and allows the nail to grow back. The nail may be able to grow back without ingrowing again.

 

If the nail border problems do recur, then a permanent nail border (or total nail) removal may be desired, This is done similarly to the non-permanent procedure, with the addition of chemical destruction of the nail matrix. This is safe for many people, requires more healing ability than for the non-permanent procedure, and patients will be evaluated to see if they are a candidate for this procedure prior to decision that the permanent procedure would be done. Often this is done for one border. If both borders ingrow, the client may elect to remove the entire nail, or to remove both borders. *Many podiatrist take large parts of the nail out, while Dr. Brown understands that the cosmetic appearance of the nail is important, so she can take less while still removing the offending border. 

For Fungal Toenails, if antifungal treatments aren't working to resolve the fungus and thickness of the nails, some clients elect to remove the nail (or nails) permanently. This is not very common and is usually reserved for clients with very thick nails and great circulation.