Over the years I have seen thousands of cases of the "ingrown toenail". I believe that just the thought of having a toenail partially or completely removed is so agonizing that it deters one from getting help in a timely manner. Some cases are so painful that the patient would wait for hours in the ER waiting room, to nearly not allow me to even look at their toe. I was once told that "even looking at it makes it hurt more". If you are a diabetic, chances are, your medical provider will refer you to a Podiatrist for any surgical type of nail removal. You will most likely receive antibiotics, antiinflammatories, a corticosteroid cream, and instruction for foot soaks prior to your appointment with the specialist. If you are not a Diabetic, and you have severe inflammation and pus drainage, your provider may elect to perform a partial nail removal along with a referral for Podiatry follow up. During this procedure, a local anesthetic will be given that will numb the toe. Sometimes, rather than removal, the provider will lift the nail upward out of the embedded skin and place a rubber splint, that will lift the nail up and allow it to grow outward rather than into the skin. An option for an ingrown nail that is only moderately inflamed, without discharge is to apply cotton packing to lift the nail. This can be done by taking the cotton from the tip of a Q-tip, and packing under the nail so that it gently lifts the nail upward. Dental floss can be used as packing too. This separates the nail from the overlying skin and helps the nail grow above the skin edge, usually in 2 to 12 weeks. At home, you'll need to soak the toe and replace the material daily and apply a corticosteroid cream after soaking. Another approach, which minimizes the need for daily replacement, uses cotton coated with a solution that fixes it in place and makes it waterproof (Collodion). As with most medical problems, the best treatment is prevention. To prevent an ingrown nail from forming, make sure to never trim your nails too short, trim them just at the edge where your skin ends. This way, the nail cannot grow into your skin as it is growing out. Also, make sure to not wear tight fitting shoes. If you should have an urgent medical need, see me at Urgent Virtual Clinic LLC. Open everyday from 8a-11pm. Online Scheduling at www.urgentvirtualclinic.com Melissa D. Roberts, PA-C
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