Infected ingrown toenail: What is it and how worried should I be?

An infected ingrown toenail is different than your ordinary run of the mill ingrown toenail.  Regular ingrown toenails, though painful and likely to severely impact your mobility and ability to engage in various activities, could theoretically be left alone until the pain became too unbearable.

Not so with infected ingrown toenails.  An infected ingrown toenail is far more serious and something you should be very concerned about.  If you have an infection in your toe we encourage you to seek professional consultation as soon as possible.  The key reason for this is that the infection introduces a myriad of risk factors, including death or toe amputation.

What is an infected ingrown toenail?

First of all, let’s talk about what an infected toenail really is. The toenail itself has not been infected, thus it would be more appropriate to refer to it as an infected toe or an infected toe resulting from an ingrown toenail. Be that as it may, the infected ingrown toenail speaks to the infection that occurs when the ingrown toenail digs into the skin of the toe and creates a wound that subsequently becomes infected.

Ingrown toenails have three stages. The first stage listed below describes your run-of-the-mill variety ingrown nail.  The second and third stages address infected ingrown toenails:

  • Stage 1: Redness of the skin (erythema) and swelling (edema) occurs when fluids collect under the skin in response to the pressure from the toenail. Pain is evident in the lateral nail fold.
  • Stage 2: Sufferers experience higher levels of pain and discomfort and can observe discharging of puss/fluid from the area where the nail meets the skin.  Bacterial paronychia, a nail disease characterized by red, hot skin is evident.
  • Stage 3: Left untreated, the body responds through a process called hypertrophy where skin/tissue cells in the infected area grow in size in the lateral nail wall.

What causes an infected ingrown toenail?

As we alluded to above, infected ingrown toenails and regular ingrown toenails are basically the same thing.  The only difference is that the former is in a more severe condition and serious state.  The cause of an ingrown toenail infection is the same thing that causes regular ingrown nails.

The likely culprits may be improper nail-trimming habits, genetic predisposition, or various forms of trauma (e.g. stubbing the toe, athletic trauma or workplace incidents). Another common culprit are ill-fitting shoes.  Women who wear uncomfortable, foot contorting heels for extended periods of time are very susceptible to ingrown nails.

Now the actual manifestation of the infection occurs for a variety of reasons and each person will be unique.  Many people report having ingrown toenails repeatedly and for extended durations without ever getting infections.  Others, may be more sensitive to infections due to compromised health or other factors surrounding how they deal with the ingrown nail over time.

If you have an ingrown toenail and your feet are constantly in moist, sweaty environments, you are probably far more likely to develop an infection as opposed to keeping your feet clean and dry.

Treating Infected Nails

Unfortunately, treating infected ingrown toenails is a little bit different than treating regular ingrown toenails.

Individuals suffering from ingrown toenails in  Stage 1 (above) have a variety of options at their disposal.  First and foremost, they can attempt to utilize home treatment remedies and other options so as to hopefully avoid ingrown toenail surgery.

These options include extended soaking of the feet in warm/hot tubs of water with some using epsom salt or other ingredients to form a soaking solution.  Immediate remedies also include the placing of various homemade splint devices under the toenail so as to elevate it and dislodge it from growing into the skin.  Sometimes this works, sometimes it doesn’t.  And of course, learning how to properly trim nails and practicing good trimming habits will take a bit more time.

When it comes to infected ingrown toenails, sometimes these options are simply not practical and patients will require surgical treatment for ingrown toenail removal.

As outlined on our homepage these are the traditional treatment options for ingrown toenails:

  • Partial toenail removal
  • Partial toenail and tissue (nail bed) removal
  • Matricectomy or Permanent toenail removal

Risks Associated with Infected Ingrown Toenails

The primary concern one needs to be worried about when it comes to an infected toe is the risk that the infection will enter the bone.  This is especially true for diabetics. If/when the infection reaches the bone in the toe, the toe will need to be amputated to prevent the infection from spreading.

Dr. Scott Kilberg of the Indiana Podiatry Group writes:

Nail tissue comes from a group of cells called the nail matrix.  Located under the skin at the base of the nail, the nail matrix grows nail outward.  It is closely associated with the end bone of the toe, which lies a very short distance underneath.

When an ingrown nail is present, and inflammation develops in the skin fold adjacent to that ingrown portion, bacteria can become trapped within and under the swollen skin.  In this tight space an infection can develop, and that is why some ingrown nails become red and drain pus.  Typically, this infection, even in diabetics, is limited and resolves with simple self-treatment measures like soaking, antibiotic ointment, or a basic oral antibiotic.

However, if this infection is allowed to smolder untreated for a long time (usually months), or if the area suffers repeated infections, the bacteria can eventually make their way down the channel alongside the nail and into the nail matrix.  From there, it is possible for the bone underneath to become infected.

For many diabetics, this can mean amputation of the end of the toe as bone infection, especially of the small bones of the foot, has a poor outcome with the extended use of intravenous antibiotics as opposed to larger bones elsewhere in the body with a better blood supply.

 

 

Staph Infection Ravages NFL Locker Room

Lawrence Tynes is a kicker in the National Football League with 10 seasons under his belt.  Earlier this offseason, he was signed by the Tampa Bay Buccaneers when their kicker tore his Achilles and was done for the year.

Shortly after signing with the Bucs, Tynes developed an ingrown toenail on his kicking foot.  As alluded to previously, ingrown toenails can occur when there is physical trauma of some sort to the toe.  For example, someone might stub their toe on a coffee table leg or furniture.  In this instance, a kicker is repeatedly crashing their foot and toe into an object (the football).

What makes this particular situation involving Tynes’ infected toenail is that he contracted a staph infection inside the team’s locker room.  This staph infection is very serious because it is resistant to antibiotics and not healing.

Tynes was signed July 17 after kicker Connor Barth tore his Achilles tendon before the start of training camp. Tynes, a 10-year veteran, was expected to compete for the starting placekicker role with Derek Dimke, but Tynes developed an ingrown toenail on his kicking foot shortly after his arrival that became infected with MRSA, a staph infection that is unaffected by some antibiotics. He required surgery last week but has not returned to the Bucs’ facility. Meanwhile, Nicks, who developed a blister on his left foot, has remained out since the MRSA infection was revealed but has received treatment in Tampa.

And Tynes’ wasn’t the only individual contracting the staph infection.  Another player appears to have acquired the infection by way of a blister on the foot.  The Tampa Bay Buccaneers responded by extensively sanitizing the facilities.

Unfortunately, this isn’t the first time something like this has happened in an NFL locker room:

[T]he Cleveland Browns had an instance with the careers of former Giants wide receiver Joe Jurecivius and center LeCharles Bentley; infections that nearly caused a loss of leg and life as well. Both had a lawsuit filed against the Browns and settled with the team as a result.

Hopefully, Tynes starts responding to treatment soon.  Obviously, staph infections are fairly rare in a relative sense. However, even while suffering from an ingrown toenail condition at home it is imperative that you take action and proactively deal with the issue before it becomes a much bigger problem.  The cost of ingrown toenail removal is relatively minor and it is foolish to avoid tackling the matter head-on.  Moreover, though there is some pain associated with ingrown toenail surgery — the pain and stress of serious infection is far greater and the consequences of neglecting your health can even lead to toe amputation.

 

 

 

Foot care advice for new moms and babies

The Idaho State Journal published an article recently on thing we can do to take care of our feet. The article had some pretty fascinating information that I was previously unaware of:

“Pregnancy creates many changes in the body, and can even affect the size of a woman’s feet,” says Dr. Matthew Garoufalis, a podiatrist and president of the American Podiatric Medical Association (APMA). “And even though newborns aren’t walking yet, it’s understandable that mothers may have some concerns about how to best take care of their baby’s feet.”

The discomforts of pregnancy are common and well-known, ranging from back pain and frequent bathroom trips to feet that are both sore and bigger.

“It’s not at all unusual for a woman to gain a shoe size while pregnant,” Garoufalis says. “Increased weight puts more pressure on the foot, the arch flattens a bit and the foot elongates. Just a quarter-inch increase in foot length is enough to prompt a change in shoe size.”

The article tips are pretty standard.  They encourage readers who are pregnant to do their best to control their weight as much as possible.  Other tips are pretty straightforward and run of the mill discouraging women from using high heels and ensuring that proper nail clipping to prevent your newborn from getting ingrown toenails.

Please take a moment to view the rest of the articles in our Women’s Health section, where we feature discussions on a variety of topics such as whether or not nail designs increase the chances of a woman getting ingrown nails.

 

Ingrown Toenail Scandal in California Prison Healthcare Debate

California, a state that is perennially facing fiscal budget deficits and challenges that often arise from its boom or bust economy and plethora of moronic politicians, has been battling it out with the justice system, public employee unions and advocacy organizations when it comes to the  provision of adequate healthcare and medical treatment to inmates in their overcrowded prison system.

In the Los Angeles Times comes a story about mistreatment of prisoners titled “Court experts cite ‘serious’ healthcare risks at Corcoran prison“:

Three inmate deaths were described as likely preventable, including that of a diabetic man who was receiving the wrong insulin medication.

The reviewers also cited repeated lapses in patient care, including the case of a man whose ingrown toenails were left unattended until [he had to have the ingrown toenails surgically removed] the nails had to be surgically removed, and a patient with valley fever who did not receive prescribed chest CT scans.

In 2006, a California court ordered the care and management of the prison healthcare system to be placed under a court-appointed official.  The prison system has been facing court ordered threats to release prisoners to combat overcrowding and improve living conditions.  Many Californians simply have not expressed much anger towards the supposed lack of quality healthcare, especially with many of them paying all-time high premiums for their medical care or lacking it entirely as the state still bounces back from the Great Recession.

What I would be curious to know is how much the state taxpayers were billed for this toenail removal since we have already established the fact that cost of ingrown toenail surgery isn’t that high, relatively speaking when compared to other surgical procedures.

 

 

 

Ingrown Toenail Surgery Cost: How much is it?

Whenever it comes to surgery or visiting a doctor for treatment of any kind, the next logical question that comes to mind is how much does ingrown toenail surgery cost? This is especially important when you are an individual suffering from the pain of an ingrown toenail and you do not have medical insurance to cover the visit and the procedure.

Toenail removal surgery is pretty darn “cheap” in the grand scheme of things in the realm of medical procedures.  Now of course, “cheap” is relative especially when finances are difficult.

Ingrown Toenail Surgery Cost for Uninsured Patients

I recently surveyed a handful of podiatrists in the Los Angeles area to ask for quotes on ingrown toenail procedures for someone who does not have insurance.  As you would expect, there was some variance in the quoted procedures and caveats based on the seriousness of the ingrown toenail.

Our survey found that an uninsured patient should expect to pay $260-500 dollars.  These figures include all the costs associated with doctor consultations and aftercare visits.  As you would probably expect, the intensive permanent nail removal operations were responsible for the quoted prices at the higher end of the spectrum.

Each office we surveyed calculated their fees differently.  Some podiatrists had a simple flat rate fee based on the temporary or permanent toenail removal surgery.  Others quoted the initial consultation and subsequent procedure separately.  Regardless, in these instances, the total did not exceed $500.

An interesting note worth disclosing here is that one doctor’s office cautioned me about the presence of an infection.  They cautioned me that were they to find an infection, the doctor would perform a temporary nail removal and prescribe antibiotics for the infection.  Once the infection went away, the doctor would then perform the permanent toenail removal surgery.  In this instance and with this doctor’s office, the cost would have exceeded $500 since it would have been similar to having two different procedures.

If you are uninsured and unsure of the severity of your ingrown nail condition, it would behoove you to inquire as to the actual cost of just the initial consultation.  As we alluded to on the homepage, most ingrown nail conditions do not require surgery and you do not want to pay more than you have to for a consultation, especially if you find out that the doctor does not need to surgically remove your toenail.

Ingrown Toenail Surgery Cost for Insured Patients

If you are currently insured you can expect to pay much less for any surgery involving the removal of an ingrown toenail.  Obviously, each providers has different copays and deductible guidelines.  However, be forewarned about unscrupulous medical practices.

Do not call up a podiatrist, or any doctor for that matter, and ask if they take your insurance.  Every doctor can take your insurance.  They will just turn around and bill you for what your insurance did not cover.  In the case of electing to visit an out-of-network provider, your insurance will not cover any of it even though the doctor “accepted” your insurance.  Therefore, you must contact your insurance provider and find out who is in your network.  Even though insurance companies have gotten much better about providing this information online, it can still be quite a chore signing in and navigating some of these provider’s websites.  If you are not going to take my advice, at the very least ask the doctor you are considering to submit to you a written estimate given your medical insurance coverage.
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In the interest of full disclosure, I have been guilty of simply asking my dentist if they took my insurance and never encountered any problems.  And odds are you will not either.  But, why take the chance.  There are some unethical doctors out there just like any other profession and there is no sense in not taking the extra time to ensure you are protected.

Local Anesthetic vs. Being Put to Sleep

The above information provided is based on the assumption that each patient underwent a local anesthetic similar to how a dentist will numb your teeth and gums before filling a cavity.  Some podiatrists will put you to sleep to perform the procedure should that be more desirable to you and your particular circumstances.  In the event you elect to be placed under total anesthesia, the costs of the procedure will increase dramatically and it is also highly doubtful that your insurance provider will cover this procedure.

Medical Reimbursement Plans

Many employers have medical saving and reimbursement plans available to their employees.  These plans allow you to deduct money from your paycheck each month and place it in a savings fund held by your employer in which you can only spend these funds on medical expenses.  The advantage of this benefit is that you do not have to pay income taxes on these funds.  Additionally, some employers will make a match of some kind similar to that of a 401k retirement plan and this effectively lowers the cost of your ingrown toenail surgery.

 

Ingrown Toenail Surgery Pain: How bad is it?

 

Most people get a little queasy when it comes to blood and needles and wonder how painful it is to have ingrown toenail surgery.  Ingrown toenail surgery pain is going to vary based on the individual and the type of procedure the doctor needs to perform to mitigate the pain and/or infection of the ingrown toenail. Anyone who gives you an absolute answer isn’t being truthful or honest.

Pain Experienced During Actual Procedure to Remove Toenail

Generally speaking, the majority of accounts submitted by patients on the internet who have had ingrown toenail surgery report that the most painful aspect of the actual procedure is the insertion of the needle used to numb the toe.  Some people report experiencing pain during the procedure on message boards and similar websites. With the overwhelming majority of ingrown toenail surgeries occurring under local anesthetic one wonders how much of this “pain” is attributable to psychosomatic manifestations.  Curiously, one must also speculate as to whether or not they were properly numbed and why they did not inform their doctor about the pain they were experiencing.

There have been instances when I visited my dentist for a filling and even after being given a shot of Novocain to numb the area I experienced pain.  In those instances, he simply gave me another shot of numbing agent and waited a few minutes before proceeding once again.


Aside from tugging and pulling sensations that come with a doctor cutting out your toenail and the pain associated with the insertion of the needle to numb your toe, you should expect to feel no pain during your procedure.

Post-Ingrown Toenail Surgery Pain

There is going to be pain and discomfort.  There is no way of getting around it.  With that said, most people will experience mild pain, discomfort and annoyance that can be adequately dealt with via over the counter pain medication like Tylenol.

With temporary nail removal for minor instances of ingrowing toenails, you are going to be able to walk out of the doctor’s office under your own power and without the need for crutches or walking aids.  The pain will subside over the next few days and usually be totally gone after about a week.

ingrowntoenailsurgerypainWith a matricectomy when the nail is permanently removed you can expect the pain threshold and duration to be higher and last longer.  There will be deep incision(s) and stitching. It is not uncommon for patients to significantly modify their work environment for at least two weeks to accommodate their condition.

You can read one person’s descriptive account of their ingrown toenail surgery experience here about their ingrown toenail surgery experience.

 

Ingrown Toenail Surgery Aftercare

Unlike many other surgical procedures that require heightened degrees of attentiveness, ingrown toenail surgery aftercare instructions are minimal since our toes can heal pretty well on their own with minimal assistance. More onerous are the directives from your doctor suggesting lifestyle and wardrobe changes.

Typical Aftercare Instructions

Frankly, there seems to be very little consistency in the instructions provided by doctor’s performing ingrown toenail surgery to patients.  Many patients will post comments on the internet about how their doctor said such and such and someone will respond with their experience and state that their doctor said something completely different.  Please note that when you read online comments by individuals recounting their experience, you have to realize that most people are generally going to comment when they have had a bad experience.  Although you will read some posts and comments by people who had a non-eventful surgery, many others will be negative and it is easy to get confused or overwhelmed by these statements.

You must also remember that you are only getting one side of the story.  They are writing what they “remember” their doctor telling them.  We truly have no idea if these individuals actually followed the doctor’s instructions.  With that said, please remember the following:

  • Many doctors prescribe their own aftercare regimen. Make sure you adhere to your doctor’s counsel
  • If you are confused or feel vague about certain aspects of the aftercare regimen, then make sure you ask the questions and don’t stop asking for clarification until you are clear you understand each instruction.  You are the boss in this transaction.  Do not let your ignorance about medical procedures cause you to remain silent out of embarrassment

A general aftercare regimen will consist of the following:

  • Get home, lay down and place your feet above your heart until the local anesthetic wears off.  This will prevent the throbbing pain that tends to occur when individuals walk around and continue to engage in activities while numbed up and the agent wears off.
    • Numbing agent will wear off in 1-2 hours — feel free to take Tylenol or Ibuprofen, as needed for pain management
    • You may experience post-surgery bleeding — this is normal.  Do not remove bandage or dressing and instead place additional dressing over toe
  • Keep your foot clean and dry until the next morning when you will:
    • Soak your foot/feet with bandage on for 10-20 minutes 2-3 times a day (You may take a shower, as well, if you feel your toes can handle the pressure of the water hitting your toes.)
    • Dissolve 1 tbsp. of table or Epsom salt per pint of warm water
    • Gently remove bandage(s) after soaking and pat dry softly before applying any prescribed antibiotic solutions or recommended creams/ointments into the groove where the nail previously existed
    • Place a new bandage/dressing on wound and repeat for the prescribed duration of recover (most likely until your first post-op appointment)
  • You may experience drainage (body waste and chemical solution) from the wound and this is normal as the body expels the root cells in the nail matrix that were killed with the chemical acid for 2-3 weeks
  • Redness around surgical area is normal unless it increases dramatically

Amerigel Aftercare Treatment Advantages and Instructions

Some patients may be prescribed an Amerigel kit for dressing their wounds.  Amerigel does the following:

  • Eliminates the need to soak wound in warm water
  • Absorbs chemical drainage
  • Contains ingredients that clean the wound
  • Is a topical antibiotic
  • Requires only once a day dressing changes vs. 2-3 with traditional methods outlined above
  • Generally heals wound one weak faster than traditional method outlined above
  • Sold over the counter and does not require a prescription

How to use Amerigel (VERY EASY):

  • After showering or bathing, blot the surgical site dry and apply the Amerigel on top of the nail bed where the nail was removed (Avoid placing the Amerigel on your good skin. Stinging may occur for a few minutes and is normal.)
  • Apply a 2×2 inch gauze over the toe and cover with a loose band aid, or coflex (If severely infected use the wound wash after your shower or bath and  prior to applying the Amerigel.)

 

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Ingrown Toenail Surgery Recovery Expectations

 

Ingrown toenail surgery is provided on an outpatient basis and as such recovery is fairly straightforward.  As mentioned previously on other pages of this website, recovery and other factors are dependent upon the extent of the ingrown toenail and the type of surgery required.

Surgical treatment that does not disturb the nail matrix and merely involves the removal of the nail sliver usually takes around a week for the nail margin area to heal.  Although patients will be able to walk out of the doctor’s office under their own power and place weight on their feet, walking will be uncomfortable. Notable healing and substantial improvement will occur in the twenty-four hour period following the surgery.  However, immediately following the surgery and after the numbing agent wears off, you will experience some main that may need to be medicated with over the county pain medication.


A matricectomy requires a little bit more healing time and can extend beyond three weeks in duration as the toe recovers from the trauma and the nail heals.  And for considerable duration following the procedure individuals will encounter significant tenderness and have sensitivity to hot and cold water.

It is important to distinguish between recovery equating to the absence of pain and discomfort during the course of normal daily activities and the absence of pain while encountering more strenuous activity. Individuals who work in a demanding occupation or lead an active lifestyle with lots of athletic activity or exercise are going to have to patiently wait for the healing process to run its course.

As the old adage goes, if it hurts when you do something…stop doing it.

Timeline Summary for Ingrown Toenail Surgery Recovery:

  • Day 1 - Regardless of which procedure you have, you will be able to walk out under your own power.  Though you will probably be able to drive your vehicle just fine, you might want to consider having a friend or family member join you at the doctor’s office so that they can drive you home.
  • 1-2 Weeks – Patients undergoing a partial toenail removal without disturbing the nail matrix can typically expect healing to occur over a period of 7-14 days
  • 2-8 Weeks – Patients with particularly problematic ingrown toenail conditions may have extended recovery time frames, especially if infection interrupts the healing process
  • 8+ Weeks – Patients requiring a full nail avulsion with destruction of the nail matrix may require more than 2 months to adequately heal.

These timelines can also be negatively impacted by the stress and strain individuals place on their healing toe(s) in the workplace or in extracurricular pursuits.

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CREDIT: TheGirlsNY via Flickr

For more information about ingrown toenail surgery, please return to the homepage.

 

Matricectomy: What is it?

When you look at the anatomy of a toenail you will see that on top of the nail bed sits something called a nail matrix.  A matricectomy derives its name from the nail matrix and refers to the process of removing it via surgery, the application of an acid chemical, or the use of a laser.  The nail matrix can be partially removed or removed in its entirety.

Matricectomies are reserved for those patients with particularly problematic ingrown nail conditions and for those who have repeated occurrences of ingrown toenails.  When we speak of ingrown toenail surgery, a matricectomy is the most aggressive form of surgical procedure to mitigate the problem.  However, there are less invasive surgical options that do not require the removal of the nail matrix.

matricectomy

Matricectomies involving the entire removal of the nail matrix are also referred to as a full matricectomy, full nail avulsion, phenolisation or full phenol avulsion.

The terms phenolisation and full phenol avulsion refer to the chemical phenol, which is a carbolic acid used to kill the matrix during ingrown toenail removal surgery.