[Doctor] Jasmine, how long has this toe been bothering you?
- [Jasmine] On and off for probably a year.
- [Doctor] Mm.
- [Jasmine] It bothers me every time I clip it, it just grows back.
- [Doctor] Looks like you've clipped it straight across, but it still gets sore, huh?
- [Jasmine] Yeah, and I lose the toenail after skiing last season. So I think it looks.
- [Doctor] Oh, looks like you have a little bit longer second toe than your other toe.
- [Jasmine] Yeah and I just went hiking Sunday.
- [Doctor] And that set it off again.
- [Jasmine] Yeah. It was a steep hike. Went hiking Sunday and a lot of downhill, steep.
- [Doctor] Oh, and that jammed it?
- Yeah.
- [Doctor] It's always this side that gets soared.
- Yes. Yeah.
- [Doctor] All right.
- And I did drain some pus out of it last night.
- Ah-huh. Just to point out for our audience, we can see over here that this definitely is red and tender there.
- [Jasmine] Yes.
- [Doctor] Don't have to do much of that to know where the problem is. And the key with the ingrown toenail is not so much whether it looks curved or as people call it ingrown, but whether it hurts. And the toe can be really curved or sometimes the toe is flatter, but the skin is bulging up. Either way, we end up with the same thing, a painful ingrown toenail, particularly one side or what we call the nail border. Given that this has been recurrent and currently it's infected, it takes two things to take care of it. First of all, your own toe nail has become a splinter. What do I mean by that? Well, what we know is when we get a splinter, we often ignore it, if it's a small one, until maybe less than 24 hours. And what happens? It turns red and we know we have to pull the splinter out. So think of your own ingrown toenail that way and we're glad you didn't try to pull it out on your own. But this side of the nail needs to come out. If we just trim a corner, unfortunately we end up with a corner here and a corner there. It's a nice idea, but it often leads to trouble because the corner then ends up down here then grows in again. So instead we numb the toe, we go straight back like this and take out this piece. We numb it back here. Luckily your toenail only goes a few millimeters under the cuticle, so there's no deep procedure. And as soon as that little piece comes out, there'll be very little bleeding. And then we'll just have you do a little wet dressing on the toe today and some simple antibiotic ointment once a day, you can shower regularly. I wouldn't run on it for a day or two, but that would be all you would need to decrease in terms of your activity level. I think if you're looking at hiking again, you'd be fine by the weekend.
- [Jasmine] So if I'm going rock climbing tonight?
- [Doctor] Well.
- [Jasmine] We'll see how it goes.
- [Doctor] Yeah.
- [Jasmine] I don't have to, I'll take it easy today.
- [Doctor] Yeah, see how you do. Probably not my advice to do that too much because you are healing up from an infection, but it will heal quickly. And then given the recurrence of the problem, you should come back in so that we can numb it back up and put a little chemical down here, because right by your cuticle, you see the little difference in the skin color under my nail here? Those are the root cells. There's no deep root anywhere else and we just have to cauterize the root cells just down that side where that nail's growing in and then that won't be back. Alright, so step one is the only uncomfortable part and I'm pretty gentle with the injection, but I would never say a needle doesn't hurt. However, after we swab your toe with little alcohol, we'll use a very, very cold spray, when all done back here, nothing's done near the sore spot and it really doesn't take much local anesthetic. Are you allergic to any local anesthetics?
- [Jasmine] No, I'm not.
- [Doctor] Like iodine or tape on your skin.
- [Jasmine] No, I'm not.
- [Doctor] All right, very good. We're going to use cold spray then. And here comes the owie. Sorry about that.
- [Jasmine] Okay.
- [Doctor] All right. That's the worst part.
- [Jasmine] All right.
- [Doctor] You still with me?
- [Jasmine] Yep.
- [Doctor] All right. Now we're going to let you numb up here and then we'll fix that.
- [Jasmine] Okay.
- [Doctor] All right. I'll scrub your toe while we're waiting. A little splash of pink soap. Here we go. Getting numby at all?
- [Doctor] A little. Yeah. Down at the base for sure. So yeah, that's pretty numb already.
- [Doctor] Yeah?
- [Jasmine] Yeah.
- [Doctor] All right. Now you didn't injure the toe per se?
- [Jasmine] No.
- [Doctor] You didn't jam it into a rock?
- [Jasmine] Right. No, I didn't stub it or anything.
- [Doctor] Okay.
- [Jasmine] It's just the constant.
- [Doctor] Yeah. Battery.
- [Jasmine] Trauma from hiking.
- [Doctor] You do.
- [Jasmine] Losing the nail.
- [Doctor] You did some climbing though?
- [Jasmine] Yeah. Yeah, did some climbing.
- [Doctor] So you do have to grab?
- Yeah. And you wear tight shoes for rock climbing.
- [Doctor] Yeah.
- [Doctor] So that doesn't help anything.
- [Doctor] I'm going to use this very teeny tiny blade. Take a little border of that nail out. Now that's pretty inflamed in there. So we're going to put a little drop more of local anesthetic in, but you shouldn't feel this one. Feel anything now?
- [Jasmine] No.
- [Doctor] Good.
- [Jasmine] Don't feel a thing.
- [Doctor] Good. Good. Any pain there?
- [Doctor] No, nothing.
- [Doctor] Good?
- [Jasmine] Good.
- [Doctor] Alrighty. Okay there?
- [Jasmine] Yep, that's fine.
- [Doctor] All right. Give it just the amount of time. So we'll clip away this edge straight back as I indicated. And the nail only goes just barely past the cuticle. So as much as it looks like I'm doing this deep, awful thing, I barely clip it. Take this teeny tidy blade and push back just a little bit. A little drop blood there. And now that piece should come out pretty easily. Good fresh red blood. I gotta make sure we got all that nail. Make sure didn't leave anything behind. That should do it. Now, we put a little ointment on there and some gauze and wrap you up snug as a bug. Tight to compress it a little bit. Keep it small enough to go back in your shoe.
- [Jasmine] I'm very glad that it is numb.
- [Doctor] Yeah, numb is good. Alright.
- [Jasmine] All right, success.
- [Doctor] Success. We're done.
