Ingrown toenails are a common problem that causes nagging foot pain and periodic infections, and are easily and permanently treated with a procedure that removes the curved border of the nail for good. Unfortunately, there are times in which ingrown toe nail surgery fails to result in permanent relief. Today I will discuss the reasons behind this.
Traditionally, ingrown toenails are removed via a procedure that trims away the ingrown border, and treats the nail root cells under the skin fold at the cuticle with an acid that destroys those cells in the corner, resulting in a permanent loss of the nail in that corner only. Sometimes, however, the nail border grows back either completely, or in the form of a partial splinter of nail. This process takes several months to develop after the removal procedure, but can potentially result in similar pain as was felt before the procedure. The reasons why this happens are several , and can involve failure of the procedure on different levels.
The most common reason why ingrown nails return following a removal procedure is neutralization of the acid by blood and body fluid present at the procedure site before it has a chance to work to kill the nail root. Blood flow is limited during the procedure by the use of a tourniquet and in many cases by a chemical in the anesthetic called epinephrine that constricts blood vessels, but on occasion blood and fluid seep into the procedure site with enough volume to neutralize the treating acid. This is especially a problem in people with poor veins or large toe bulk. This leads to only partial destruction of the nail root in the corner, and a return of nail growth soon after.
Another reason for failure is acid that is too old. If a physician only performs a limited number of these procedures a year, the bottle of acid will sit unused for a long time, and eventually become 'spoiled' and ineffective.
Yet another scenario for failure includes abnormally deep nail root anatomy in which part of the nail root can be inadvertently 'missed' during the procedure, or nonvisible skin or scar tissue that blocks access of the acid to the nail root itself.
Finally, some people assume that a procedure is going to permanently address the ingrown nail, when in fact it is only temporarily designed to temporarily remove the offending nail border to relieve pain. This often happens at family practice offices and emergency rooms, where the physicians do not stock the acid or generally are not trained to perform the procedure completely. While these procedures, called nail avulsions, do instantly relieve the ingrown nail symptoms, the symptoms eventually return when the nail border grows back out to length.
The good news in all this is that the procedure can be repeated if it fails, and usually on the second go around it is successful, leading to permanent relief of ingrown nail pain.
Until next time,
Scott R. Kilberg DPM
www.inpodiatrygroup.com - foot doctor and podiatrist in Indianapolis
thediabeticfoot.blogspot.com - diabetic foot information
YouTube videos on foot disease and foot injuries
A foot doctor in Indianapolis Noblesville Fishers Carmel Westfield and Fortville Indiana.
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