I’ve had a problem with an ingrown nail on my big toe every
soccer season I can remember. Last fall, when it got infected
and especially painful, I went to my brother’s family doctor.
He took out the whole edge of the nail and showed me a spike of
nail that had been hidden under and was piercing into the skin.
After a week of soaking and taking an antibiotic, I was a happy
camper. NOW I’VE GOT THE SAME PROBLEM! How can that be if he
took away the whole edge (even under the cuticle)?
First, you should know that what your doctor did was most probably
temporary procedure from the start. The cells that manufacture new
nail plate were left intact. Most ingrown nails are one-time
occurrences; once the "bad growing" nail is removed, the replacement
that grows in behind it is normal. In such a case, the problem was
just temporary, and there was no need to destroy the so-called
"matrix cells." To better explain this, let’s go back to the basics
of nail anatomy (yes, we had to take a course in this in podiatric
medical school) to see what caused the problem. Then we’ll discuss
the temporary and permanent procedures (and their rationale) and
finish-up with some extras: Nail Pathology. (No, it was part of
the SAME course).
Please take a minute to study the diagrams of the nail.
An ingrown nail is made of two components - the flesh (skin or
nail fold) and the nail plate which may have a SPICULE. Most
usually, the edge of the ingrown nail is irregular. This may be
from trauma (which splits the nail) or from inappropriate trimming
(you missed the absolute last bit of the nail’s edge when cutting).
As the irregular border presses into the flesh, it may or may not hurt.
With time and nail growth, the place where it presses may become a minor
cut, a great place for bacteria to hang-out. (And better yet, your foot
will be in a warm, dark, and maybe MOIST shoe - microorganisms LOVE
that!) PUS and the accompanying INFLAMMATION (swelling, redness, pain
and warmth) are signs of an infection. Now two things have to resolve:
the infection and the original offender, the spicule.
Soaking in warm salt water as well as use of an antibiotic ointment
will help fight the infection. This may also soften the spicule,
which may eventually grow out, away from the skin. If it continues
to pierce the flesh, often a GRANULOMA forms. This, so-called
PROUD FLESH, is red, angry tissue, a bundle of nerves and vessels
at the spot of irritation. It is a very good idea to see a doctor
to address both aspects of the concern. She or he may do a partial
nail avulsion (that is, take away the offending portion of nail and
clean-up the site while the to is numb), and may suggest the use of
antibiotics to clear up any nasty-looking infection. You will
experience MUCH relief (as our previously-HAPPY CAMPER can profess,
immediately. It’s even worth the anxiety over the needle, which
admittedly is the worst part of it for doctor and patient alike.
Although you may not be able to avoid the damage caused by an
object falling on your toe nail, or avoid the jamming your toe
experiences when you inadvertently but repeatedly kick with your
big toe, there are some things you can do to prevent ingrown
nails:
Do not use caustic "home cures" on an already ingrown nail. No
medicine will make your nails grow straight. You either inherited
nail growth tendencies or your environment has set you up, and only
proper care will "save" you. Be sure your shoes fit correctly in the
toe when you are doing the activity for which those shoes were
purchased. That is, is there enough room to kick, fun, jump, dance,
etc.?
It takes about six months for a new nail to grow from the matrix
cells underneath the cuticle to its full length at the end of your
toe. (This is an average; often nails grow faster in children and
during the warmer months.) Some times, despite proper care to avoid
an ingrown nail and/of prompt medical attention to an earlier one,
you may have a recurrence in as little time as four months, as did
our friend, CAMPER. In this case, the cause was apparently not
temporary. Apparently, either the nail fold remained THICKENED,
and an OBSTACLE for the new growth of nail or there was damage to the
MATRIX, those cells that fabricate the new nail plate. This calls for
more aggressive measures. If we are unable to persuade the new nail
edge to grow over the flesh without ingrowing, we may grow over the
flesh without ingrowing, we may address that portion of the matrix
that is the underlying problem. There’s no NICE way to say it : we
kill that section of matrix, either with a strong chemical or we
surgically cut out those cells. Your anticipated recovery from
this "more permanent" procedure is quite similar to that for the
simple partial avulsion, except maybe longer. The reason I refer
to this as "more permanent" is because even getting rid of specific
matrix cells does not always give "forever relief." (There are few
guarantees in medicine, unfortunately.) Many unseen things can happen,
and even the surgical procedure carries a chance of regrowth or
recurrence of an ingrown nail.
In any given week of practice, we may see quite a variety of toe
nail problems. Next issue we will devote another short article to
nail problems and their treatments. Fun stuff, eh?
We welcome your comments and your questions. Please
e-mail your concerns to
Chesterfield Podiatry Associates,
c/o
Old Dominion X Press
Signed,
Most Frustrated Camper
Dear Camper,
Terms
(No quiz, though.) Especially note the NAIL PLATE, NAIL BED, and MATRIX.
Also, know that the skin beside the nail is termed the NAIL FOLD.
The Ingrown Nail
Avoidance
Recurrence
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