Ingrown toenail

[trippclark]

I did a forum search and was surprised to find nothing on the topic. Here is the situation and I'm seeking insight or advise.

About three years ago, after hiking a section of the trail, my toenail on my left big toe, which had given minor problems before, really started acting up. Finally, after the pain was unbearable, and home remedies/prevention techniques had failed, I went to the local Doctor's Care. After meds to clear up infection, I returned for "surgery" where they removed all but a little of the nail.

Now, three yaers later, then problem is back and nearly as bad as before. I had had no pain until a recent 40 mile backpacking trip two weeks ago, but it looks like the pain is here to stay.

I guess I can go back and have the same surgery again, but I am reluctant to do so because (1) it was not effective long term before, (2) it was obscenely painful to a point that words can not describe it.

I am not optimistic that anything short of this will help though. The whole right side of the nail is ingrown -- not just the end. I'd love to hear of some alternative that some of y'all might be aware of that actually works!

[Jaybird]

OUCH!



as my buddy, & hikin' mentor, Model T would say:..."watch out for the feet."
if they'/re miserable..you're gonna be miserable....

this problem sounds like it occured a longtime before you stepped onto the trail. And it "flaired" once you put some high mileage on your "dogs."

foot problems can be very serious...whatever you need to do to remedy it...seek out & get it done.

[illininagel]

I guess I can go back and have the same surgery again, but I am reluctant to do so because (1) it was not effective long term before, (2) it was obscenely painful to a point that words can not describe it.

I know exactly what you are going through. The entire right edge of my big toe nail was ingrown. As you say, it was obscenely painful to even touch the thing. After taking medication to reduce the infection, I also went through the surgery in which half of the nail was removed.

Less then a year later, the nail grew back exactly the same way. So, I decided to give another podiatrist a chance.

The second podiatrist was surprised about how the first doctor treated the ingrown nail. He told me that it would continue to grow back the same way forever unless the procedure was done properly. From what I understand, the proper procedure is to kill the nerve when removing the nail. He told me that it would ensure that the nail would never grow back that deep again.

Fortunately, he was right! It's been ten plus years and I've never had another problem with the ingrown nail.

People that haven't had one of these have a hard time appreciating how painful they can be. My grandfather had an ingrown nail and complained that it was more painful that his open heart surgery!

I recommend that you find a highly qualified podiatrist to treat your nail. Best of luck to you...

[trippclark]

Yeah, the surgery is what killed me. The injections of anesthesia in and around the toe and under the nail using a needle as big around as a wooden pencil lead. Then cutting the darn thing out with what looked like kitchen scissors and needle nosed pliers!! YIKES!!!

It is worth it, I guess, if the problem goes away. But man, that was one horrific experience that I am NOT looking forward to repeating!!

[illininagel]

Yeah, the surgery is what killed me. The injections of anesthesia in and around the toe and under the nail using a needle as big around as a wooden pencil lead. Then cutting the darn thing out with what looked like kitchen scissors and needle nosed pliers!! YIKES!!!

Well, that sounds exactly like the experience I had with the first podiatrist that I visited. They could hear me screaming out in the waiting room.

The experience at the second podiatrist was entirely different. The nail was just as infected, yet I didn't feel hardly anything when he inserted the needle. Believe me, if you go to a doctor that knows what he is doing, the procedure is relatively painless.

Hopefully, you know someone that can refer you to a good podiatrist. It makes all the difference in the world.

[Weeknd]

Hey I agree. I think that you got a podiatrist with bad procedure. When I had mine done 5 years ago, the Dr inserted lidocain with a really small needle around my toe. Then some other meds that made my toe swell up. Then he used a special little chisel with a hammer to cut the nail back all the way to the root. I remembering him saying that getting the root was the key. Then, he put some kind of acid on it bandaged it up and sent me out. Didn't hurt until a couple hours later. Took me about 5 days to get well.

Find you a good doc. Ask around for folks with good experiences.

[trippclark]

No doubt the doctor used was likely a factor. He was a GP, not a podiatrist.

[Footslogger]

From what I can tell, if you're prone to ingrown toenail then most likely you're going to get them ...regardless of whether surgery is performed or not.

I believe the key to ingrown toenail is regular nail care. By regular, I'm talking about every couple days or so. I'm an ingrown toenail type person. Back home where I generally wear sandals or soft toed trail shoes I typically cut the toenails straight across. However, despite the classical recommendation regarding the cutting of the nail straight across, I cut mine (large toe) with a sharp curve toward the two edges prior to and during my thru in 2003. I took a file and smoothed off the edges after cutting. I used that approach sucessfully from Springer to Katahdin and would use it again in a heartbeat.

Of course, having enough room in the toe of your boot/shoe is a big piece of the puzzle. Even a properly cut toenail can become problematic if the toes are crowded and under pressure from footwear.

I've talked to dozens of people who have had "surgery" to correct ingrown toenail and to my surprize the majority of them have recurrent problems. I just don't think the whole toenail thing is a one-shot process. It's one of those maintenance issues that takes common sense and regular attention, especially if someone is predisposed to ingrown nails in the first place.

'Slogger
AT 2003

[Pencil Pusher]

I had these on both big toes. Of course they used the big fat needles. I maybe would've felt better had I not been looking at that thing. No fun. A temporary relief is to cut a deep V into the middle of your toenail. I can't remember why the thing wasn't cut, but they did that V to tide me over. For the removal, they took off about a quarter of the nail and then applied this acid. The acid did the trick and I haven't had a problem since. It's been about 12 years.

[orangebug]

Infected inflammed toenails make the toe ultrasensitive, making the injection very difficult for anyone. I don't know if Sloetoe is on this list, but he has a similar story from cutting a toenail short on the first few days of his thru-hike, and hobbling into Hot Springs with a nasty infected toe. Any treatment feels better than the infection.

There are a few strategies to reduce the pain of the injections, including some pressure on the nerve to begin to numb it. However, it will hurt. If you aren't "medical," you will be grossed out by the surgery, which is a fairly common instrument of torture - removing toe nails.

Some prefer to allow at least one opportunity for the nail to regrow with the owner/victim educated how to trim and care for the nail better. It is a very reasonable idea to occasionally get a pedicure in order to reduce the chance of ingrown nails and to see how it should be done. I like to get a pedicure after a week or two of section hiking - something like a reward.

It is worth learning this, especially as you grow older. Your nails will get harder and skin will encroach more easily. Infection can lead to Bad Things, including amputations, systemic infections and falls.

OrangeBug

[sloetoe]

Infected inflammed toenails make the toe ultrasensitive, making the injection very difficult for anyone. I don't know if Sloetoe is on this list, but he has a similar story from cutting a toenail short on the first few days of his thru-hike, and hobbling into Hot Springs with a nasty infected toe. Any treatment feels better than the infection.
OrangeBug

http://www.backcountry.net/arch/at/9908/msg00162.html
STILL hurts just to think about it....

[trippclark]

Heading to a well recommended podiatrist tomorrow. Praying for no pain!

[trippclark]

Well, I delivered myself to the recommended podiatrist, Dr. Joseph Moran. I must say that the difference between this procedure and the last one I had was so dramatic that I cannot possibly put it into words. I felt NOTHING except for two small stings as he administered the novocain and then some minor pressure as he worked. I was amazed that two doctors could perform the same procedure and it be so vastly different. He removed part of the nail, and used an acid to kill the root so that it will not grow back on that side. Now begins the two weeks of aftercare, but so far I am very impressed! I should be back in regular shoes by Monday. Thanks illininagel and others for encouraging that I seek out a well trained podiatrist. This should make my next trip on the Trail much better.

[illininagel]

I'm glad to hear that everything worked out for you. It is amazing how two different doctors can treat something like an ingrown toe nail so differently.

[Pencil Pusher]

My experiences were those from the Frankenstein-technique military doctors. Three injections with a fat needle for the ingrown and my mind was effing howling while my face was distorted and in reality just shocked by this suck-ass way to 'numb' my big toe. Then I remember the needle of death, another fat needle bastard, but this one encased in a metal sleeve with two metal finger holes near the plunger. The Frankenstein dentist presented me with such a contraption and forever damaged my inner child and rooted a deep seated fear of dentistry. If toenail removal without anesthesia is a form of torture, so too must be messing around with the teeth.

Thank god the doctors and dentists you pay for with your hard-earned money actually make things relatively painless nowadays. My resulting (non-military) dentist visits have left me wanting to kiss the dentists afterwards. "Rahhnn ru rarreh ruhh. Rrrrih rah rrreh rrrahenrehh."