Chemical Matrixectomy for Ingrown Toenails

Ingrown toenails are a common complaint of patients visiting a podiatrist. This involves the nail plate growing into the surrounding skin, most commonly at either the medial or lateral borders of the nail, with or without a localized infection. They can be very painful, and generally will worsen over time. In the presence of infection, a small abscess may form at the area of the ingrown nail, with a small amount of pus present. The infected skin will become red and swollen, and there will likely be some discharge from the area.

In the podiatrist’s office, these are typically dealt with by excising the offending border of the nail. This consists of making a small cut in the nail longitudinally, and rotating the ingrown border out of the skin. This procedure is done under local anesthesia to minimize the discomfort to the patient during the procedure.

Once the nail border is taken out, a common procedure is the chemical matrixectomy. This involves taking a strong chemical and essentially burning the nail matrix that produces the nail. By burning the matrix, the nail is prevented from growing back in that area, thus preventing recurrence of the ingrown toenail. The chemical matrixectomy has a very high success rate, with a reported recurrence of only 5-7%.

The process most commonly involves the use of phenol, a strong chemical used to burn the nail matrix. Phenol causes proteins to denature, which will not allow the nail to grow back where it is applied. The phenol is usually applied to the nail matrix several times. A piece of gauze may be used to protect the surrounding tissues, so that they are not damaged by the phenol. After the use of phenol, alcohol may be used to dilute the solution. The procedure is commonly referred to as a “P&A”, which stands for phenol and alcohol.

Some clinicians may prefer to use sodium hydroxide to remove the nail matrix, though phenol is much more commonly used. If sodium hydroxide is used, it is followed by an application of acetic acid to neutralize the reaction and stop the damage to the tissues.

Following the chemical matrixectomy, the surgical site is treated like a burn. Silver Sulfadiazine is often used as an antibiotic, and the wound is dressed with a bandage. The procedure will generally heal very well, with minimal time off of work and activity. Generally the doctor performing the procedure will want to follow up with the patient in a week’s time to ensure that the site is healing and there is no infection.

Central Florida Foot and Ankle Center

101 6th St Nw

Winter Haven, Fl 33881

(863) 299-4551

www.FLFootandAnkle.com

Are You Drinking Enough Water?

We all know we’re supposed to drink plenty of water, but how much is enough? Various studies have been conducted on the question, but the only consensus has been that water is vital to normal function. Our bodies, on average, are composed of around 60% water, making it the most abundant chemical of the human body.  Water is vital to virtually all of our bodily functions, making it critical to replace the water lost every day.  On average, we lose about 1.5 liters of water per day from urine output, as well as another liter from breathing, sweating, and other bodily functions. 

            One theory of how much water we should drink comes directly from this calculation.  The idea is to replace the water that we lose, approximately a liter and a half.  Another approach to this idea is the general rule of drinking eight 8-ounce glasses of water per day.  This is sometimes referred to as the 8x8 rule.  Still another idea is to follow daily recommended values for water.  These values are about 3 liters per day for men and about 2.2 liters per day for women.  This amounts to about 13 cups per day for men and about 9 cups per day for women.

            Of course, the amounts for all of these explanations are adjusted based on various factors, such as activity level, climate, health conditions or illness, and pregnancy.  For exercise lasting 20-30 minutes, an extra cup or two of water is necessary to replace fluid from sweating.  For longer exercise programs, especially those lasting over an hour, more fluid is needed.  Drinks with sodium and potassium are recommended, as these electrolytes are also lost in great numbers during extended periods of exercise.  Drinks such as Gatorade, Powerade, Vitamin Water, or any other drink containing electrolytes will do.

            In warmer climates or in altitudes of over 8,000 feet, additional fluids are necessary.  Pregnant women will also have an increased demand for fluids, as well as those with a cold or flu.  Symptoms such as diarrhea, vomiting, and fever will increase the body’s need for water as well. 

            Though water is usually the best choice for staying hydrated, other fluids will do as well.  Sports drinks and juice will count towards the daily water intake, as well as soda and coffee.  Even beer and wine will count, though these should not be used as replacements for water. 

            Waiting until you’re thirsty to drink water may not be the best way to keep hydrated.  In fact, your body’s signal that you are thirsty is already a sign that you are dehydrated.  The best way to stay hydrated is by drinking a cup of water with each meal, as well as a cup in between in each meal. 

            A good way to judge whether or not you are getting enough water is to pay attention to your urine.  A healthy person’s urine is clear or light yellow.  If you’d like more help on getting the proper amount of fluids in your diet, you can talk to your doctor or a certified dietician.  

Central Florida Foot and Ankle Center
101 6th St Nw
Winter Haven, Fl 33881
Phone: (863) 299-4551
www.FLFootandAnkle.com

The “Ow” in Ingrown Toenails!

What is an ingrown toenail?

An ingrown nail is defined as when the skin on one or both sides of a toenail develops over the nail edges or when the nail itself grows into the skin.

The medical term for the condition is onychocryptosis. Although it most commonly occurs on the big toe, the lesser toes may also be affected.

What are some reasons for ingrown toenail occurrence and the resulting pain?

Ingrown toenails may be caused by a variety of factors. They can have genetic origins; the nail is just too large for the toe or may be curved, leading to the predisposition of the condition. Or they may be due to trauma to the area such as stubbing your toe, dropping a heavy object or having it stepped on.

Improper clipping of toenails such as trimming too short leads to skin inflammation and shoe friction upon that skin further increases the pain. An impacted toenail can first be seen directly after improper grooming of toenails. The nail looks like it has been cut back too far and there is exposure of the pink tissue around the edge.

 Running often and hard leads to formation of ingrown toenails because the pressure on the toes from the shoes. Wearing tight shoes or shoes too small for the feet also lead to the condition because the toes have no room and the nails are becoming compressed.

How do you know that you have an ingrown toenail?

            Besides causing discomfort and pain, there are other indications that lead to the diagnosis of an ingrown toenail. The signs of a toe with an ingrown toenail are redness, swelling, tenderness and rigidity. In some cases, there may be pus drainage from the area of the impacted toenail. In addition, the condition will not fix itself and the nail will not correctly grow out. The nail keeps growing into the tissue surrounding it and increasing the severity of the pain. When you take a toenail clipper to the nail, it will become harder to trim the nail back. The skin around the ingrown toenail is very sensitive to touch and even contact with socks and shoes will inflict pain! In addition, an ingrown toenail may lead to infection causing further inflammation and pain!

            Read on further for more information on the prevention and treatment of ingrown toenails!  

The “Ow” in Ingrown Toenails! Part 2

Ingrown toenails are a common and uncomfortable foot condition that cause a lot of pain and discomfort. There are many reasons for ingrown toenail occurrence and some of those causes can be eliminated with education and hygiene.

What are ways to prevent an ingrown toenail?

            The most frequent causes of ingrown toenails are improper toenail clipping and tight shoe wear. Both of these reasons can be easily remedied.

Toenail clipping

            Many people are unaware that there is a certain technique involved when it comes to clipping toenails.  Toenails should never be longer than the tips of your toes, but do not cut them too short as to reveal the soft pink tissue underneath. This skin tissue is easily inflamed, causing pain.

When attempting to cut toenails, make sure to use proper toenail clippers. A normal nail cutter has slightly curved cutting edges while a toenail cutter has edges that are straight across in order to reduce the likelihood of ingrown toenails. Observe the natural line of your toenails and when grooming toenails make sure to trim them straight across. Do not round off or cut the corners of your nails or pry the corners when cutting.

Shoe wear

            Proper-fitting shoes are essential for good foot health. Small, tight shoes not only compress the toes and toenails, they do not allow your feet to breathe, lead to foot discomfort, and may even affect the biomechanics of your walking. When shoe shopping, do it in the late afternoon or evening because you feet are at their largest size. In addition, make sure your foot size is measured every time before purchasing shoes to ensure an appropriate fit.

What are treatments for an ingrown toenail?

            There are a variety of non-invasive and invasive (surgical) treatments for an ingrown toenail.

-          Soak your foot in warm water

-          Wear comfortable shoes with a sufficient room for your toes

-          Consider wearing open-toed shoes to prevent shoe material from touching the affected area

-          Take aspirin or ibuprofen for pain relief

As soon as you detect an ingrown toenail make an appointment with your podiatrist! An ingrown toenail may be complicated by an infection, so it is best to leave your problem in their hands. In the case of an infection, your doctor may prescribe oral antibiotics. Surgical intervention may be necessary to remove the offending part of the nail and prevent infection. A partial or complete nail avulsion is a procedure where the doctor injects anesthetic in your toe and then instruments are used to cut away the ingrown toenail portion without disturbing the nail bed. If you follow your podiatrist’s recommendations, you will minimize your discomfort and hopefully prevent the reoccurrence of the problem!       

Central Florida Foot and Ankle Center
101 6th St Nw
Winter Haven, Fl 33881
Phone: (863) 299-4551
www.FLFootandAnkle.com