Many patients who have had ingrown toenail correction at the Canadian Foot Clinic & Orthotic Centre are amazed at how relatively painless and effective our minimally invasive procedure is, often stating that they have suffered for years needlessly because of “horror stories” they have heard from friends and family who may have had an older more invasive procedure done elsewhere by non-foot specialists.
One of the specialty services offered at the Canadian Foot Clinic & Orthotic Centre is ingrown toenail correction using the minimally invasive, stitchless chemical matrixectomy procedure (see partial permanent nail avulsion) also called the P & A Procedure, typically resulting in patients returning to their normal activities within just days after the procedure with a very high success rate.
If you’ve suffered from ingrowing toenails and are tired of the pain and discomfort, this may be among the best procedures for your condition. We will attempt to treat your ingrown nail with the least invasive, most effective procedure possible given your individual requirements while taking your lifestyle into account.
We will educate you as to your options and answer any questions you may have to arrive at the most appropriate procedure for you. We do not proceed unless you are completely comfortable and pain-free after using local anesthetic to numb your toe. Aftercare is reviewed and a dressing package with antibiotic cream dispensed to save you another trip to the pharmacy. We typically will follow up with you after a procedure to ensure proper healing.
What are ingrown toenails?
Ingrown toenails may be due to trauma, poorly fitting shoes or the natural curved shape of your nails which predisposes you to getting this condition
The nail acts as a foreign body (much like stepping on a pin or nail) and pierces the skin, exposing your toe to infection. If not treated promptly, the infection may spread and in those with poor circulation or diabetes may lead to bone infection and even amputations.
The nail may continue to grow into the side of the toe. This can lead to progressive pain or recurring infection. It is most serious in people with underlying medical problems such as diabetes or peripheral vascular disease. In some cases the infection may progress up the foot or to bone and require I.V. antibiotics and more invasive surgery up to and including amputation. It is important not to neglect this problem and to deal with it appropriately and quickly.
Topical and oral antibiotics may help reduce some of the signs of infection but this is often only a temporary fix. In order to avoid prolonged pain and infection, the offending ingrown nail border must be physically removed from the flesh.
For the below procedures, “permanent” procedures involve destroying part or all of the nail root typically with a chemical, whereas “temporary” procedures do not. Also, “partial” refers to a sliver of nail whereas “total” refers to the entire nail.
Debridement (aka Trimming)
Often times patients just assume they need a surgical procedure when all they need is regular trimming of ingrowing toenails with gentle buffing of the incurvated corners (see Foot Care – Medical Pedicures). We will evaluate your needs and try to avoid surgery if at all possible.
Slant–back procedure (aka Wedge Resection)
A wedge of the offending nail edge is cut back typically without using local anesthetic. This may be helpful if the ingrown portion of the nail is at the tip of the toe. This will not work if the ingrowing border is near the root of the nail. Local anesthetic is typically not employed although we may use a topical “cold spray” for comfort. Usually only offers temporary relief and regrowth is common because it does not change the curved shaped of the toenail.
This is the most common procedure done if we cannot simply just trim away the ingrowing part of the nail. The toe is numbed up with a fine needle using local anesthetic. The area is made sterile for this minor operative procedure. A tourniquet is used at the base of the toe to temporarily stop blood flow. About a 3 mm sliver of the offending nail including that at the root is removed. A chemical (phenol or sodium hydroxide) is applied to the nail root to kill the cells that are producing that portion of the ingrowing nail, then neutralized. In the vast majority of cases that portion of the nail does not grow back and permanent relief from the ingrown toenail is usually achieved.
Temporary Partial Nail Avulsion
The toe is numbed up with a fine needle using local anesthetic. The area is made sterile for this minor operative procedure. A tourniquet is used at the base of the toe to temporarily stop blood flow. About a 3 mm wedge of the offending nail including that at the root is removed. Usually provides several months of relief. Once the nail grows back it is likely to become ingrown again at some point. This may be performed if it is the first time you’ve experienced ingrown toenails or if you have underlying medical conditions resulting in slow wound healing.
Total Nail Avulsion (Temporary or Permanent)
If both nail borders are involved or if the nail is very small, the entire nail can be removed. This procedure can be done temporarily or permanently.