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Nail Disorders
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Ingrown Nail
Painful ingrown nails may be congenital, caused by an over-curvature of the nail or an imbalance between the width of the nail plate and the nail bed. Toe injuries that change the nail's contour also can lead to an ingrown toenail.
Toe deformities (such as a bunion that forces the big toe to lean toward the second toe), high-heeled or narrow, pointed shoes can put pressure between the nail and soft tissues, eventually forcing the nail to grow into the skin.
Symptoms include redness, swelling and infection which can make the toe very painful. Ingrown nails can be accompanied by other toe disorders, such as excess surrounding tissue or an outgrowth of bone beneath the nail.
Surgery is often necessary to ease the pain and remove the offending nail. Only a portion of the nail may be removed. If the entire nail is affected or there is a severe nail deformity, the nail plate and matrix (the cells that grow the nail) may be completely removed.
Fungal Infections
Various types of fungi are present everywhere in the environment. The dark, moist surroundings created by shoes and stockings make the feet especially susceptible to fungal infection.
Most fungi are harmless until they penetrate the skin. A fungus can invade through minor cuts, or after injury or repeated irritation to the toes have caused the nail to separate from the bed. Fungal infections of the nail plate and nail matrix are quite common.
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Treatment is best begun at the early stages of infection. The accumulation of debris under the nail plate can lead to an ingrown nail, or to a more serious bacterial infection that can spread beyond the foot. To reduce pain associated with a thickened, infected nail, the surgeon may reduce its thickness by filing the nail plate down with a surgical burr.
Filing will not, however, prevent the infection from spreading. Oral and topical medications may be prescribed when:
- Only a small portion of one nail is infected
- Several nails are affected
- Keeping the nail is desired
While topical ointments usually do not eliminate the fungus, they may be effective when used directly on the nail bed, after the nail plate has been removed. Eliminating the infection, in some cases, can only be achieved by permanent removal of the nail plate.
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A very common result of active lifestyles is blood, or a hematoma, beneath the toenail. Hematomas are especially common among people who jog or play tennis, caused by the toes repeatedly rubbing against the shoe. A hematoma might indicate a fractured bone, especially after an injury (such as dropping a heavy object on the end of the toe). The toe should be examined by the podiatric foot and ankle surgeon, who may take an xray to determine the most appropriate treatment.
If the hematoma is treated within the first few hours of forming, the foot and ankle specialist may will create a tiny hole in the nail plate using a fine-point drill or scalpel. This releases the blood and relieves pain.
If several days have passed and the blood clot becomes painful, the nail plate may require removal so that the nail bed can be cleaned. Some podiatric foot and ankle surgeons prefer to remove the nail plate whenever blood forms beneath it, because the blood can attract fungi and lead to infection.
The nail may also be removed to treat a bone fracture beneath the hematoma. If the bone has fractured but has not moved out of its normal position, a splint may be used to keep the toe aligned during healing.
Nail plates that have been removed will grow again within three to six months.
Surgical Treatments for Nail Disorders
If the ailment is severe or chronic, surgery to remove all or a portion of the nail may be recommended. Most surgeries are performed very comfortably under local anesthesia, and require less than one hour at the foot and ankle specialist's office. Laser surgery, because it requires special equipment, may be performed at a hospital.
We Can Help
The podiatrists at Northwest Surgical Specialists are leaders in both conservative and surgical treatment of all nail disorders. For additional information, please contact one of our three convenient locations to arrange a consultation.
3100 W. Higgins Rd., Ste. 150
Hoffman Estates, IL 60169
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Foot & Ankle Care
Pain Management
Physical Therapy
Therapeutic Massage
Skin Care
Surgical Care Center
431 Summit Street, Suite 102
Elgin, IL 60120
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Foot & Ankle Care
Physical Therapy