A true ingrown nail (onychocryptis) is where a piece of the main nail splits and grows into the sulcus and penetrates the skin. It usually affects one side of one of the great toenails. The area becomes painful, red and swollen. Often, the area becomes infected with a discharge. It is often seen in teenagers and is associated with the nail and skin changes that take place in this age group. It may also be due to shoe pressure, not cutting the nails straight across, or pressure from the adjacent toe.
Another type of ingrown nail is the involuted nail. The sides of the nail plate turn in abruptly and dig into the sulcus. This may be due to hereditary factors, damage to the nail bed, too tight shoewear or it is sometimes seen in psoriasis. If the nail presses on the skin in the sulcus often, callous or corns may form. The area now becomes hard and painful.
Regular Podiatry Treatment
The nail can be thinned and reduced with any corn or callous formation in the sulci to be removed. The daily application of tea tree oil to the nails may be recommended. Tea tree oil is an antifungal antiseptic which lubricates the sulci so the nail will be less likely to dig in as it grows forward.
A partial nail resection and phenolisation of the matrix is a nail surgery carried out with the use of a local anesthetic. The anesthetic is injected at two points at the base of the toe. A sterile field is created. A tourniquet is applied to the toe and blood is pushed out of the toe. A sliver of nail is cut and removed from one or both sides of the nail plate. The slither is further removed with the forceps with 10% to 20% of the nail plate removed. An opening down to the matrix (root), which lies just above the bone, is created. This allows access to the matrix. Phenol, a powerful caustic, is carefully applied to the part of the matrix to be destroyed. It is left in place and then neutralized and flushed away. The phenol chemically burns and destroys the part of the root it is applied to. This part will not grow back and 10% to 20% of the nail will never re-grow. The result is a permanently narrower and flatter nail. The tourniquet is released and as the blood returns into the toe, the toe may bleed. The bleeding is stopped and a sterile antibiotic dressing is applied. The procedure takes about 45 minutes.
When the anesthetic wears off at home, the patient will experience pain similar to a burn pain. They will take whatever pain killing medication they would usually take for pain or a headache. The toe will usually become red and discharge for 7 to 10 days. Each day the patient will carry out a 5 minute salt water foot-bath followed by the application of an antibiotic dressing. They will return to our office for follow up visits. The procedure is approximately 90% successful.