Ingrown Nails

Post-Operative Instructions for Nail Surgery


You have just had minor surgery.  Please realize that the success of the procedure depends upon your following of these instructions.
1.    Remember that your toe will look like it is infected for 6-8 weeks after the procedure.  This is normal. 
2.    Take pain medication as directed.  (Tylenol or Advil)
3.    If you see some minor bleeding at the operative sight, this is expected.   Apply direct pressure on the bandage for 5-10 minutes, this will stop the bleeding.
4.    You are to begin soaking as follows the day after the procedure:
a.    3 quarts of warm water with 1 tablespoon of Epsom salts for 20 minutes twice a day. 
b.    Clean the borders with a Q-tip from the bottom of the nail to the tip.
c.    Dry the area with a clean towel and apply antibiotic cream (Neosporin or Bacitracin) to the surgical site.
d.    Cover with gauze and tape for the first couple of days.  After that may cover with bandaid.   The first few bandages may stick to the wound.  If this happens soak off the bandage in the shower or soaking basin.
e.    Repeat all of the above twice daily until directed to discontinue.
5.     As an alternative to the soaking and antibiotic cream, you may purchase Amerigel and apply that to the bandage twice daily. 
Return to the office as appointed.  If you have any questions or problems call the office at 
(845)562-7285.

Ingrown nails are known to physicians as onychocyptosis.  They are common, painful conditions that occur when the nail grows into the skin.  

Ingrown toenails can develop for many reasons.  In some cases the toenails are simply too large.  Persons whose toes curl (congenitally or from disease such as arthritis) are prone to onychocyptosis.  Trauma, such as stubbing a toe or having one stepped on can cause a piece of the nail to jam into the skin.  Frequent running also can cause ingrown nails.  Ingrown nails can be caused by trimming them incorrectly, causing them to regrow into the skin.  By excessively tight stockings and by shoes with narrow toe boxes.  Bedridden patients commonly develop ingrown toenails if the bed sheets are kept tucked in tightly.  

 Uninfected ingrown toenails cam be treated with the following regimen:  soak the foot in warm soapy or salt water, dry thoroughly with a clean towel, apply a mild antiseptic solution to the area and bandage to the toe. 
Various over the counter preparations are available that can harden the skin and shrink the soft tissue along the edge of the nail so it grows normally.   A soft, foam toe cap can be worn while the ingrown nails heals. 

Onychocryptosis should be treated as soon as it develops.  If the skin is red, painful or swollen on the sides of the nail, there may be a infection.  The ingrown nail is in a warm, moist and bacteria rich environment and it provides a convenient entry for germs that can cause infections.  At first the skin around the nail may be mildly red or inflammed.  Untreated, the nail can go under the skin, causing a severe infection.  The infection must be cured using sterile instruments and antibiotics.  People who attempt to fix an infected toenail themselves may worsen the problem.   An infected ingrown toenail should only be treated by a physician.  

A podiatrist can trim or remove the infected nail in the office with a minor surgical procedure.  A portion of the nail or overgrown skin is removed with a scalpel and the infection is treated.  

If an ingrown toenail recurs, it may require a more permanent solution.   A smail portion of the nail and the nail matrix (the part of the nail that actually grows) is removed with a scalpel or burned with a chemical solution.  This makes the nail narrower and prevents the nail from growing back, enduring that it will not irritate surrounding skin.  The chemical treatment is a slightly less invasive procedure.  It caused mild inflammation that lasts about a week.  This procedure often can not be used in severe cases because the chemical used (phenol) may neutralized by the infection.   In these cases the physician must remove the ingrown toenail with a scalpel.

Unless the problem is congenital, the best way to prevent ingrown toenails is to protect the feet from trauma and wear shoes with adequate room for the toes.  Nails should be trimmed straight across with clippers to a comfortable length.