WHAT IS A NORMAL TOENAIL?:

Normal toenails should have the same essential shape and texture as normal finger nails.   They should be relatively thin, flexible, smooth, pink and only mildly curved, side to side and flat front to back.  The cuticle near the base of the nail should be thin and flexible.  The nail folds flanking three sides of the nail should have a low profile and be the same color and texture as the skin on the rest of the top of the toe.  They should not cause any pain or discomfort in properly fitted stockings, socks or shoes.  They can be easily trimmed or pared with lightweight nail nippers or nail scissors.  

WHAT IS AN ABNORMAL TOENAIL?:

"Onychocryptosis (nail edge "hidden" in the flesh):"   There are several common causes of painful toenails.   In this instant, an "ingrowing" toenail is a painful condition where a nail edge or part of it is painfully puncturing or is about to puncture the adjacent skin; it may be infected too; some consider this a “complicated” ingrown nail.  An ingrowing toenail is usually a painfully disabling condition where an usually curved or arched nail edge is pressing down and onto adjacent flesh; it may also be inflamed; some consider this a “simple” ingrown nail. Each of these can cause an ulcer or growth under the nail or its edge.

 An abnormally wide toenail (type of deformity) is a irritating condition where the nail edge pushes sideward into it adjacent skin fold; it can become painful enough to interfer with the wearing of conventional shoes.  A thickened toenail (onychauxia or onychogryphosis) exerts abnormal pressure on the delicate tissues under the nail (nail bed or “quick”); it is difficult to cut with non-professional nail instruments and skills.   Fungus-infected toenails (onychomycosis) and psoriasis-affected toenails (a psoriatic pachonychia) can also be thickened and troublesome too.  

HOW TO PERMANENTLY FIX AN INGROWN / INGROWING TOENAIL.:

The goal of treatment is to permanently alleviate the suffering by surgically altering the growth, shape or position of the toenail.  In over 34 years of podiatric practice, we have easily performed these more hundred and hundreds of times. The vast majority of these corrections involve fixing one or both MARGINS on one or more toes. This is referred to a "partial permanent nail and matrix excision" (PNME). Our success rate easily exceeds 95%.

HOW WE GENTLY PERFORM A NAIL MARGIN CORRECTION:

A partial permanent nail margin and matrix excision (PNME) is performed in the office almost exclusively. We don't do anything until you and the doctor agrees what needs to be done and where. Then the treatment chair is reclined so that you don't "peek."  The doctor speaks to you and calms you as the toe is put to "sleep" (with an injection of local anesthetic around the base of the toe - NOT anywhere near the ingrown nail bothers you!). In 5-7 minutes the entire end of the toe is fast asleep; it will remain so for between 1-10 hours. Once the toe is asleep (the doctor does check first), only about 3-6 mm of the offending nail margin is painlessly removed. The limited portion of the root which produced this troublesome margin is painlessly scooped out of this nail margin "pocket. Any invisible remnants of the root cells still present are painlessly inactivated with natural chemicals. The nail margin wound is covered with an antiseptic dressing.  No sutures are needed; no sutures are put in; no sutures have to be removed! Once the procedure is done and dressed, we go over all of the details on how you are to take care of your toe daily while it is healing. You go home and spend only about 6 hours with you foot elevated to a horizontal position. The doctor may recommend your taking over-the-counter (OTC) acetaminophen (e.g. Tylenol) as labelled for just 24 hours. Depending on your age, health, circulation and other factors, the wound is usually, sufficiently healed in 2-4 weeks. Pos-operative infection occurs about 4% of the time, considering that the surgical site cannot be totally disinfected due to the nooks and crannies of the nail margins and other nail irregularities; if it does happen the doctor promptly deals with it.

TOTAL, PERMANENT NAIL AND MATRIX REMOVAL (TNME) is also performed in the office to completely eliminate a problem, entire nail plate - permanently.  Again, the skin is not cut and sutures are not needed.  A technique similar to the above is again used, this time involving the entire nail and and its entire root area. Your daily, home post-op care is similar, but longer. Again post-op infection may occurs about 5% of the time and is promptly delt with.  Usually, 93% of the time, the nail does NOT come back at all - as expected.  Considering the area which must gradually fill up with skin, healing takes longer (than with a partial nail correction), usually between 3-6 weeks.  If pressure on the nail bed is minimized, there is no significant post-op disability.  The deformed, painful nail is usually replaced with just slightly thickened skin.  

LET US HELP YOU TOO !

In the past 34+ years, we have performed well hundreds and hundreds of these toenail corrections, with over a 95-98% percent success rate.  Most often the procedures are performed in our office setting under local anesthesia.  In special circumstances we use the facilities of the HealthSouth Connecticut Surgery Center under temporary sedation and local anesthesia.

Almost without exception, our patients tell us time and time again that they had little or no significant post-operative soreness.  More often than not, over-the-counter analgesics (such as Tylenol, Advil or Aleve) is more than enough to tide our patient over the first day.  It is the very rare patient that requires a prescription pain killer.

Patients are directed to take it easy for 4-6 hours following the corrective procedure so that their healing toe has a good head start.  The next day, they are allowed to resume whatever activities they desire if their comfort level will allow it.  Usually the toe is kept dry for the first 48 hours.  Thereafter, they are allowed to resume normal bathing.  Until then, bathing is facilitated with the use of special latex mitten or sock.

The patient is encouraged to contact us if there are any concerns about the post-operative progress. One week post-operatively, the patient returns for a follow-up visit. Depending on the number or size of their healing areas and then specific progress, the patient may be seen one to three more times.  Barring complications associated with a rare infection or unanticipated slow healing, healing proceeds uneventfully. If realignment of a toe is required 6-8 weeks may be required before normal activities can be resumed. Most TNME's are sufficiently healed in 4-6 weeks. Most PNME's are sufficiently healed in only 2-3 weeks.

There is really no good reason to suffer with ingrown toenails. Relief is nearly a phone call away.  We are eager to help you eliminate this annoying problem as we have for so many others from Wethersfield, from around Connecticut and beyond.

We look forward to serving you, your family and friends for this and other foot and ankle concerns.

Dr.Ken Sokolowski