Ingrown Toenails: What to do and what NOT to do

One of the most common foot conditions that we see in our Charleston and Mount Pleasant practice in adults and children are ingrown toenails. An ingrown toenail most commonly affects the big toe, known anatomically as the Hallux. When an ingrown toenail occurs, the nail grows abnormally into the skin and flesh of the toe. This leads to pain and the overgrowth of skin tissue at the side of the nail.

Sometimes the edge of the toenail pierces the skin outside of the nail groove, beginning to act as a foreign body. Sometimes a nail is ingrown not only at the corner of the nail plate, but all the way down. The first signs of either condition are pain and swelling. The area of penetration may bleed or become infected, producing pus.


Causes of an Ingrown Toenail?

The condition is caused by any of several factors. The most common of which is probably improper nail trimming, cutting the nail too much, so that when it begins to grow back it grows out of the “nail groove” directly into the flesh of the toe.

In addition, some people are hereditarily predisposed to developing the condition.


Symptoms of an Ingrown Toenail?

Severe pain, infection, swelling, sometimes pus, are major symptoms of the condition. It is normally obvious with a visual inspection, which will show that the nail is in fact growing into the skin and flesh of the toe, and that an infection is present.

Treatment for Ingrown Toenail?

If you have an ingrown toenail, it is best to see your foot specialists for advice. Any toenail that is bleeding, excreting pus, or swollen should be examined by a doctor. Many people with ingrown toenails delay treatment, or make matters worse by resorting to home remedies that may be more painful than medical attention.

Painless Surgery for an Ingrown Toenail?

If the condition has resulted in permanent overgrowth of the tissue surrounding the nail margin, or in recurring infection, surgery may be required to treat the condition. Surgical treatment varies slightly depending on the particulars of each individual case.

In mild cases, removal of a portion of the tissue at the side of the nail groove may reduce pressure and irritation. In this procedure a wedge of tissue is removed and the healing process allows the groove to reform itself.
Sometimes surgery involves use of a local anesthetic and removal of a portion of the toenail and its root. Patients with recurrent ingrown nails may require the use of a medication known as liquid phenol, which permanently removes lateral portions of the nail matrix

In our practice we use a  topical anesthestic before the injection called Ethly Chloride which freezes the skin to make patient's more comfortable.

Surgery for ingrown toenail is painless and easy to perform in the office setting. Patients should be able to put weight on their feet immediately after surgery but walking is uncomfortable. In most cases, toenails grow normally after surgery without imbedding themselves into the skin.

It is important to carefully follow instructions before and after any surgical procedure in order to have the best results and quicker recovery time. Changing the style of footwear you use is very important such as wearing a wider toe box shoe.

Our practice is proud to introduce a convenient post surgical kit for ingrown toenail surgery after care. The Amerigel Post-Op surgical kit is offered to every patient who has undergone a permanent nail matrixectomy. This wound healing kit allows for quicker healing times, eliminates the need for soaking after nail procedures, and aids in compliance by our patients.

The Amerigel Post-Op Surgical Kit has allowed our patients to obtain an effective wound healing product with all the dressings right at the time of service.

From Dr. Saffer Regarding his own flat feet....

I personally have had flat feet my entire life. Luckily I was treated by a Podiatrist at a young age with custom orthotics to assist in arch support. I also learned some techniques over the years to allow me to participate in competitive sports and most recently over the past few years long distance running.  I have been able to run in the Cooper River bridge run the past four years without injury.  So I would like to offer my best advice, based on my own experience, on how to care for your flat feet and run without pain or discomfort.

This will be a two part series first focusing in on finding the proper motion control running shoe, being evaluated for orthotics, and stretching.

Part two will focus on starting a running program and tips to ease discomfort in your flat feet during and after your runs.

Things You'll Need
The correct running shoe
Over the counter or custom foot orthotics
Consistent stretching exercises
If you have flat feet then starting with the proper running shoe is the first step

1) It is worth your time and money to go to a specialty running store to be fitted for running shoes. You should first have your foot measured to make sure you haven't changed shoe sizes over the years. The next step is looking for a anti-pronation running shoe or "Motion control" running shoe. In my experience you need to try on these running shoes in the store and go outside and jog in place to see if they feel comfortable. The "Brooks Beast" in my opinion offers the most motion control but is to heavy and bulky for me. The running shoe that I have used over the past four years has been the "Mizzuno Alchemy". I really leave it up to the individual because if you suffer from flatfeet you may be more of a degree of pronation than others. I personally am as flat as one can be so this specific shoe has worked for me. In addition while your are at the running store look for a moisture wicking sock which well help to "wick" away moisture from your feet to help prevent blister formation.

It is almost equally important to be evaluated by your local Sports Podiatrist if you suffer from flatfeet. X-rays and clinical evaluation are essential steps in having the proper diagnosis and treatment plan. X-rays would be able to give information with regards to degree of flattening of the arch and if arthritis, stress fractures, or bone spurs are presents. In addition it is important to evaluate if your flat arch is flexible or rigid which can be easily tested in the office. At the time of the office visit it will be determined if you need a really good over the counter orthotic or custom foot orthotic. The custom foot orthotic is typically the best treatment and can be made according to the given sport you participate in. The orthotic is made from a plaster impression of the feet and a specific prescription is written out for the type of sports orthotics to be fabricated. Most insurances do cover custom orthotics and they take two weeks to be made.

So now that you have the proper running shoe and orthotic the next step is stretching. I personally like three stretching exercises to begin with. The first stretch involves taking a stretching band or towel and placing it on the balls of your feet. Pull the stretching band or towel towards you and hold for three sets of thirty seconds. The next stretch is the runners stretch. Same hold three sets for thirty seconds. The third stretch is placing our feet against a stair and leaning forward for three sets of thirty seconds. These three stretching exercises stretch the achilles tendon and plantar fascia ligament to get you warmed up.

Another stretching device that our practice utilizes is the plantar fascia/achilles night splint. The night splint assist in stretching the plantar fascia ligament and achilles which in turn helps to prevent plantar fasciitis and achilles tendonitis. Our practice has tested various night splints and we are able to offer them at each of our two locations West Ashley and Mount Pleasant.

RICE it up when it comes to Foot Pain

If you've hurt your foot or ankle, it's best to err on the side of caution. The acronym RICE can help you remember what to do:

Rest—Rest the affected area. Stay off the injured foot or ankle until it can be fully evaluated. Walking, running, or playing sports on an injured foot or ankle may make the injury worse.

Ice—Apply ice to the affected area as soon as possible, and reapply it for 15–20 minutes every three or four hours for the first 48 hours after injury. Ice can decrease inflammation.

Compression—Wrap an elastic bandage (such as an Ace® wrap) around the affected foot or ankle. The wrapping should be snug, but not so tight as to cut off circulation.

Elevation—Elevate the affected extremity on a couple of pillows; ideally, your foot or ankle should be higher than your heart. Keeping your foot or ankle elevated also decreases swelling.

Dr. Andrew Saffer of the Carolina Foot Specialists office in MT Pleasant can help if foot pain is hindering your daily activities.

His office is located at 501 Bramson Ct, Suite 301 in Mount Pleasant. Call him today at 843-654-8250

Dr. Andrew Saffer, DPM 

More Tips for Healthy Feet

Trim toenails straight across, but not too short. Be careful not to cut nails in corners or on the sides; this can lead to ingrown toenails. Persons with diabetes, poor circulation, or heart problems should not treat their own feet, because they are more prone to infection.

Make sure that your shoes fit properly. Purchase new shoes later in the day when feet tend to be at their largest, and replace worn out shoes as soon as possible.
Select and wear the right shoe for each sport or activity that you are engaged in (e.g., running shoes for running).

Alternate shoes—don't wear the same pair of shoes every day.

Avoid walking barefooted. Your feet will be more prone to injury and infection. At the beach or when wearing sandals always use sunblock on your feet.

Be cautious when using home remedies for foot ailments. Self-treatment may turn a minor problem into a major one.

If you are a diabetic, please contact our office and schedule a check-up at least once a year.

Tips for Healthy Feet

Don't ignore foot pain. It is not normal. If you experience any type of persistent pain in the foot or ankle, please contact our office.

Inspect your feet regularly. Pay attention to changes in color and temperature. Look for thick or discolored nails (a sign of developing fungus), and check for cracks or cuts in the skin. Peeling or scaling on the soles of feet may indicate Athlete's Foot. Any growth on the foot is not considered normal.

Wash your feet regularly, especially between the toes, and be sure to dry them completely.

Diabetes and Your Feet

Diabetics are more prone to various foot problems than those without diabetes due to the development of painful nerve damage called peripheral neuropathy. Neuropathy can affect your entire body, but most often the legs and feet are the most prone areas to serious health complications.

The damage to your nerves can cause the loss of feeling in your feet, making it difficult to detect extreme temperatures and pain as easily, or readily, as someone who does not have diabetes. As a result, you could sustain a serious cut or wound and not even notice your foot is injured until an infection begins. Many diabetic foot problems can be prevented in some measure with improved blood sugar control and a strengthened immune system.

If you are among one of the millions of people in the United States with diabetes, it is important to visit us at Carolina Foot Specialists for regular foot examinations in order to maintain healthy feet and a strong body.

Heel pain isn't normal

Plantar fasciitis is the term commonly used to refer to heel and arch pain traced to an inflammation on the bottom of the foot. More specifically, plantar fasciitis is an inflammation of the connective tissue, called plantar fascia, that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Overpronation is the most common cause of plantar fasciitis. As the foot rolls inward excessively when walking, it flattens the foot, lengthens the arch, and puts added tension on the plantar fascia. Over time, this causes inflammation. Dr. Adam Brown of Carolina Foot Specialists in Charleston, SC explains in this video.