Some of my patients with ingrown toenails have wondered why I frequently need to do two procedures instead of one to relieve their pain. When a patient first comes to see me with an ingrown toenail, the first step is taking their history to find out how long they've had their symptoms and what's already done at home to treat them. I'll also assess whether the side of the nail that's been painful is red, swollen, has any drainage, or pus.
Once that's done I can decide whether they need a simple course of oral antibiotics, soaks to the toe, a change in shoes, and or a review of how to trim their toenails. I'll also decide whether temporary or permanent removal of the nail is needed.
Resolving Infection and Temporary Removal of Ingrown Toenail (Nail Avulsion)
When there's been an infection which shows up as recent drainage of the nail, redness, or swelling of the skin around the nail border, temporary removal of a piece of the toenail must be done first.
This procedure is called a nail avulsion. It's done at the office, takes only a few minutes, and is relatively painless. Afterwards, the inflammation around the toenail border usually resolves within a couple of days. Patients are asked to soak their toe at home to assist in healing the infection.
A second more permanent procedure, called the matricectomy, can only be done after the infection has resolved. In this procedure the "root cells" which lie just under the toenail are cauterized to prevent reoccurence of the ingrown toenail.
You might wonder why the matricectomy isn't done first. It can be done first if you had no redness, drainage, and in my evaluation no sign of inflammation in the nail border. It's not uncommon to find no redness but some swelling of the tissue, pain on exam, and drainage during the procedure. That's when I must limit the procedure to the nail avulsion.
If the nail has simply been tender for a long time but doesn't have any of those other indicators of infection then the permanent procedure can be performed at the first visit. Otherwise the safest thing is to do the nail avulsion first and then the matricectomy.
A chemical is used during the matricectomy to cauterize the root cells. It would be like pouring gasoline on a fire if the toe was still infected. But by the time you heal up from the first procedure, usually within a week, it is safe to do the matricectomy to help prevent reoccurence of the ingrown toenail. Following the second procedure it takes about two weeks to heal and it's my responsibility to check your toe at that time to be sure all has healed well.
If you have an ingrown toenail, call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.
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Seattle foot and ankle specialist, Dr. Rion Berg offers foot care for patients with bunions, heel pain, diabetes, fungal toenails, ingrown nails, and surgical solutions when needed to residents of Seattle, Bellevue, Kirkland, Shoreline, Lake Forest Park, Mountlake Terrace, Lynnwood and other surrounding suburbs.