Ingrown Toenails

John A. Brandeisky, DPM, FACFS

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Dr. John Brandeisky

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Ingrown toenails most commonly occur on the Hallux ( the large or Great toe ). Ingrown toenails can occur, however, on any toe and on either side of that toe. The condition is most common in children over eight years old and in adults younger than 60.

The toenails grow from a "root" that is located at the base of the nail and under the skin and on the end toe bone. This root is called the matrix and it constantly produces a specialized keratin substance similar to skin cells that we call toenails. The nail that grows from the root is as wide as the toe is wide. Normally this width is the same and the toenail grows out in proportion to the toe.

Several things can go wrong with the root. If it becomes damaged, for instance, the nail may have a split in it, ridges, or may not grow at all. If the root becomes infected with a fungus, the nail can be thickened, curved or brittle. If the root grows wider than the toe, it produces a nail plate that is wider than the toe as well. This is the beginning of the ingrown toenail.

When the nail plate is wider than the toe, the sides of the nail are not accommodated by the space allowed by the toe. The edges are then forced to grow into the skin. As you walk and wear shoes, the edge of the nail rubs and eventually breaks skin. This is the beginning of the process which hurts. After 24 hours, an infection may occur compounding the pain. Without treatment the infection becomes worse, the toe swells, becomes red, more painful, and begins to drain and produce pus and excess tissue that we call granuloma.

Simple treatment is to use anesthesia and remove the "offending" edge of the nail. While this works and solves the problem along with soaks and antibiotics, it is only temporary. The nail root will continue to grow the nail, and the problem most likely comes back within 6 months!

The procedure I utilize cauterizes or removes only the small portion of the root that causes the ingrown part. It is painless, heals quickly and is over 90% effective in permanently removing the problem!



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