Ingrown Toenails - Karin Bruckner
Karin specialises in nail surgery and does procedures to prevent ingrown toenails from reoccurring. Onychomycosis (nail fungus) is also a special interest of hers. Patients seen by Karin are athletes, retirees, diabetics, children and anyone needing foot care. Her practice is nestled at the foot of Table Mountain in Vredehoek, also known as Devil’s Peak, which is close to the centre of Cape Town with easy access and parking. The surgery is equipped with the latest technology including computerised gait analysis (RSSCAN) equipment, laser, and a nail debriding machine. The laser which is available at the practice allows for treatment of nail fungus infections without the side effects which can result from drug therapy. It’s non-toxic and can treat all ten toes in 15-20 minutes with no downtime.
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What are ingrown nails?

The term “ingrown toenail” (onychocryptosis) is often used to describe a number of problems that lead to pain and discomfort around the nails despite the fact that in many cases the nail does not actually “grow” into the skin around it. These problems most commonly occur on the big toe, however, smaller toes can also be affected.

What causes pain around the nails?

  • Improper cutting. A true ingrown toenail (onychocryptosis) is where a small nail spike pierces the skin leading to pain and infection. This normally occurs at the tip of the nail along the sides when a spike in the nail remains from improper nail cutting techniques or trauma. Nails should be cut following the contour of the toe or straight across with the white edges at the corners visible.

 

  • Poor fitting footwear. Tight shoes restrict room for nail growth and can cause microtrauma. This can lead to ingrown nails.

 

  • Involuted (curved) nails. Sometimes nail edges curve into the skin, meeting closer to the middle, this could be due to trauma or changes due to pressure from shoes over time.

 

  • Wide, flat nail plates are a genetic predisposition. Only when the toe box of the shoe makes contact with the toes in the shoe, does the side soft sulci of the nail become traumatised and painful.

 

  • Corns, calluses, and dry skin along the sides of the nail sulci due to pressure can lead to pain and even infection.

 

  • Trauma, either from an acute injury to the nail or anything that causes the nail to be damaged repetitively (such as playing soccer) can also cause an ingrown nail. Common traumas include:
    • Once-off occurrences such as dropping things on your toe.
    • Continual microtrauma such as lots of little knocks from activities like running, sports or wearing pointy-toed shoes.

How is it treated?

 

Ingrown toenails are treated in two ways:

  • Conservatively with cutting techniques.
  • A simple nail surgery designed to permanently remove the small side of the nail and changing the width of the nail growth plate.

 

Chances are, if your nail is repeatedly painful enough for you to be researching this, then it should probably be checked out by a podiatrist.

nail-surgery

Surgery:

 

If ingrown toenails are a recurring problem, it is generally recommended that a podiatrist performs an in-office procedure whereby the offending piece of nail is removed either on a permanent or temporary basis.

 

Karin Brückner specialises in nail surgery. This is done in her surgery, with no downtime.

 

After the local analgesia is applied, by injection at the base of the toe, it is often a fairly painless experience with most people reporting little to no pain after the procedure and being able to go back to work the next day, with a wide shoe or sandal.

 

The nail wedge resection and matrix sterilisation with phenol is an office procedure done under local anaesthesia. After the ingrown nail is removed including the growth plate. The application of a chemical repeatedly applied in the matrix space left behind, ensures that the nail will regrow the width of the plate that will be comfortable in the footwear. A dressing is then applied and at the follow-up consultation the next day, the dressing is removed, and home dressings are supplied to use daily. Follow up visits are encouraged but not always needed. It can take 3 to 5 weeks of small dressings or plasters on the toe following the procedure.

 

It is possible to do the nail wedge resection with sedation. This involves the assistance of an anaesthetist, at Karin’s rooms, which is an additional cost of the anaesthetist but there are no theatre fees involved. This is useful if you want to be sedated during the procedure.

 

Another option is full analgesia; this is however done in a day ward at a hospital and not paid for by the medical aids and is for your private cost.

Prevention

With ingrown toenails, prevention is better than cure. Here are a few tips for preventing ingrown toenails:

 

  • Wearing the right shoes. Shoes that do not rub on the side of your toe or squish them too close together. This doesn’t mean you have to wear unattractive shoes, it just means that you should choose shoes that won’t put any unnecessary forces on your toes, and that hold the foot at the bridge of your foot allowing space in the toe box.

 

  • Buffing down the thickness of nails (gryphotic) toenails. This will reduce pressure on the surrounding skin. This is done in a routine consultation in the rooms. Karin Brückner has suitable equipment to make this easy and pain-free.

 

  • Proper nail cutting techniques – cutting straight across and not digging down the sides, make sure the edges are rounded off with a file and you can see the white free edges on the corners.

 

Conservative treatment may include:

  • Seeing a podiatrist to get the spike, nail edge or dry skin removed. It is often less painful and more effective when done by the right podiatrist. After all they see plenty of these and are equipped with the right tools for the job.

 

  • Salt water soaks. Whilst they won’t cure ingrown nails, they are often recommended as the first step for newly infected nails. It is suggested to soak your foot in a salt water foot bath (1 tablespoon of salt in a litre of lukewarm post boiled water) for 10 mins and follow by dressing with an antiseptic and a plaster until you can get some professional help.

 

  • Taking the pressure off the area. This can be achieved by wearing less pointy shoes.

 

  • Antibiotics are rarely needed as they do not solve the problem alone. Whilst the toe may often seem to improve with the use of antibiotics, the infection often returns if the nail is not attended to professionally.

 

  • Lifting up the corner of the nail, by taking a small piece of cotton or gauze and rolling it to form a small roll or wick. This is placed between the nail and the skin to keep it elevated and to relieve pain and pressure.

 

  • Eliminate the cause of the problem.

Complications:

 

  • Granulation tissue

Persistent chronic ingrown toenails have a bright red growth along the sulci, this is an accumulation of tissue such as blood cells, bacteria and scar tissue in response to trauma and infection. It is not serious however it can be quite painful and tends to bleed if traumatized, leading to continuous cycles of infection and swelling. When the ingrown nail is removed surgically or resected by a podiatrist it usually resolves on its own with the help of silver nitrate which is painlessly applied at the time of resection.

 

  • Cellulitis

Whilst reactive cellulitis (redness in the immediate surrounding area) is quite common, in some cases, such as in diabetics, circulatory disorders and other debilitating illnesses, the infection can spread and an ascending cellulitis can occur. Cellulitis must be treated as soon as possible by a doctor.

 

  • Ulceration or gangrene

A complication in the infection site may begin to break down. This can lead to ulceration, sepsis and lastly gangrene. The patient must immediately be seen by a doctor.