Molly S. Judge DPM, FACFAS

Ingrown Nail

What you don’t know about an Ingrown Nail can definitely hurt you

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Ingrown nails are perhaps the most common nail deformity known to mankind. This deformity of the nail plate can be benign and tolerated for a life time without difficulty. Unfortunately there are conditions under which the uninteresting nail deformity develops into a real medical problem. You’ve probably seen a case or two in your own home. It’s not uncommon to have a family member complain that they have a painful toe nail. Sometimes it’s simply from a bad trim job leaving a sharp corner cutting into the skin.
Given this condition many people will report to what they feel is the most sanitary room in the house, you guessed it, the bathroom. They’ll put their foot up onto the toilet lid; you know to get a better look at the subject. Then they’ll use what ever instrument they can find to pick, prod, dig and cut at the offending nail corner. A common result of this in home surgical procedure is an infection. Depending on just how contaminated the instrument was it can really be a doozey. Once done, the patient may have a low grade sense of embarrassment about the problem and then begins trying to ignore that they have a problem. This results in an infection that is allowed to fester for days.

If you’re wondering, the word fester in my opinion translates into the making of pus. Yeah, I know pretty gross but I see it all the time. I’m sure that most people reading this wouldn’t believe that they or any of their family members could let such a thing happen but trust me the pain of an ingrown nail can aggravate a bathroom procedure in even the most rational person.
Many mechanical factors can transform a simple ingrown nail into a flaming infection. Overly tight shoes can cause direct pressure on the toes causing the side of the nail to dig down deeply into the skin. A common example is a person who wears those pointy little dress shoes to a wedding reception and then dances all night despite the crippling pain that the shoes cause.

The next day the pain and pressure that results from that heavy weight-bearing injury can be excruciating. If left unchecked this condition can develop into an infected ingrown nail. Fig. 1 represents just that injury left unchecked for 2-weeks time. You can see the dark, red, swollen skin around nail corners that are dug into the soft tissue. Yes, that toe was decidedly warm to the touch and there is an unpleasant odor coming from it.

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Figure 1

Ingrown Nail port clinton

Figure 2

To put it another way my medical assistant felt faint after noticing the fragrance of the toe. (An injury that won’t get her workman’s compensation but clearly earns her a badge of courage in patient care.) When you begin to show signs of redness beyond the area of the ingrown nail corner it often means that you have a bacterial infection. A bacterial infection can move very quickly into the foot and ankle. This movement of infection within the skin is called cellulites. If this is left unchecked it can land you in the hospital. People with these out of control ingrown nail infections frequently present to the emergency room (ER). So frequently in fact that many medical students get their 1st course in foot surgery while rotating in the ER.
Other injuries can cause a previously benign ingrown nail into a serious infection. In fact, the simply injury of stubbing your toe can cause enough trauma to begin a true blue infection. Naturally, after you stub your toe you figure it’s going to hurt for a few days. Unfortunately, your body isn’t very good at deciphering between the pain of a contusion versus the pain of an infection. In this man, he stubbed his toe 5-days ago and thought he was simply nursing a bruised toe.
Instead he wound up in my office and needed an injection to numb the toe so that the pus good be drained from beneath the ingrown nail.

Once a simple infection like this is drained it generally will heal with basic measures such as applying antibiotic ointment and keeping it clean & covered with a band aid for a week or two. Unfortunately when this same problem happens to a child often times they will try to hide it from their parents for fear that they will be carted off to the doctors’ office. Fig 3 If a kid can hide it long enough an infection can run up into the foot and fail to stop even with antibiotic pills. In that case they’ll probably land in the hospital needing intravenous (IV) medicines and sometimes even surgery.
Often times I meet patients that feel the need to defend their reasons for self treatment, their bathroom surgery. And they are adamant that they treated themselves properly. Sometimes I think people just watch so much medicine based television that they become overly confident in their in-home practice of medicine. Between what’s currently on TV; Scrubs, House, ER, Grey’s Anatomy and the discovery channel people get an in-home education in medicine that they are free to practice on themselves.
Unfortunately this often times leads down the road of bigger medical issues and occasionally embarrassment. Here’s the “for instance” case. This patient comes into the office complaining of a painful, red, hot and swollen toe. When asked how this developed she said that she just stubbed her toe 2-weeks ago, “I didn’t break it because it would hurt a lot more if I did… “. Obviously she trusted the medical intuition bestowed upon her from routinely watching Scrubs & ER. I looked at it and saw much more than a stubbed toe.

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Figure 3

Seen below in Fig 4. It was dark red, almost purple with a lot of little water blisters all over it. You could see that there was drainage around the ingrown nail but this was much more than your run of the mill infection. So, did she stub her toe? Yes. Was she just nursing a bruised toe or contusion? No. This lucky young lady not only allowed a traumatized ingrown nail to become infected but now her athletes foot infection has turned it into a monster infection. Nice, just what a girl wants to hear, “you have a toe nail infection complicated by a fungus”.

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Figure 4

The upside is that there are oral medications that you can take for the bacterial infection and creams that you can use to fight the fungus. It’ll take a while, probably a couple weeks but it’ll get better in an average healthy patient. So what’s the downside? For her it’s that she did break the bone in her toe and she’ll probably be able to tell you when it’s going to rain given the arthritis that will develop. So much for television based medical intuition.

Molly S. Judge DPM, FACFAS Completed a three year surgical residency program in major reconstructive surgery for the leg, foot and ankle. She is a Board Certified Foot and Ankle Surgeon with further Board certification in reconstructive foot and ankle surgery. She has offices in Port Clinton, and Toledo, Ohio. Her practice focuses on hard-to-manage cases of pain and deformity of the legs, ankles and feet and consultations for reconstructive surgery. She is the Official Foot and Ankle Physician for The Jamie Farr Owens Corning Classic.

Picture of female in sportswear stretching in exterior with foot on railing.

Molly S. Judge DPM, FACFAS

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