Talk:Ingrown nail

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Contents 1 disadvantes 2 EWWWWWWWW 3 Appropriate Voice? 4 Second Opinion? 5 Wedge resection 6 V in Toenail 7 History 8 'Problem of the West' phrase 9 Unrelenting need for pain and pressure 10 From Personal Experience 11 Any Difference? 12 "Going through the end of your shoes" 13 cut straight? 14 An addition to Causes 15 This article is horrible 16 Silver Nitrate 17 How does that work? 18 Phenolisation and Wedge Resection 19 "If Left Untreated" section

[edit] disadvantes

"Disadvantages: the procedure will fail in about 2 to 3 times out of one hundred." This needs a citation. It's failed 3 of 3 times for me.

This is quite graphic I should say... Anyone agrees that another article without pictures should be created just as the article for gangrene? And add warnings before the article begins? --Starryboy 19:24, 25 December 2005 (UTC)

It's indeed rather morbid. JFW | T@lk 02:18, 26 December 2005 (UTC)

I'd recommend against creating a duplicate article, because it will be harder to keep them in sync. I've tried creating a template at Template:PotentiallyDisturbingImage (feel free to edit it -- it's just a stub), and putting it at the top of this article. Does this help? --Arcadian 03:23, 26 December 2005 (UTC)

That certainly is a nice idea, but I wonder why now not even a word of warning is on the article for gangrene... I'm gonna add that.--Starryboy 06:03, 28 January 2006 (UTC)

I have added and subtracted to this article in accordance with my own clinical experience of treating ingrowing toe nails. The warning now in place is a good idea, although the photos are not the worst I have seen! If you are suffering from an infection like this the photos give some consolation. Ixobel

[edit] EWWWWWWWW

That's all I have to say. Ewwwwwwwwwwwwwww. Can't we get the point across without such icky pictures. I mean the article on childbirth doesn't show a photo of the kid's head coming out of the vagina!

Well, some people might need to actually see a picture of an ingrown toenail before they make any decisions and call a doctor. In fact, that's ehy I came to this particular page (yes, I'm going to have to call a doctor :( ). However, I wouldn't be adverse to some kind of warning. The rex 03:39, 21 April 2006 (UTC)

Don't get the townail removed permanently - it only causes problems for the rest of your life! It makes your toe super-sensitive to any kind of pressure, you can't kick a ball with the front of your foot, toe is easily injured, etc. Mine grew back, fortunately, but then when I had a recurrence and the doctor cut away the sides of the regrown nail, the sides never grew back (thanks, Doc) - that caused similar problems to complete removal. Best thing to do, just massage the toe area along the sides of the nail and avoid wearing shoes when possible, that made my third recurrence go away :D

I've had 4 ingrown toenails and not once did I have one that resembles the one in that picture.

Then, buddy, ya didn't have ingrown toenails. Anyway, here are some pictures of my poor brother's toe that might be superior to the ones on the article's page. Maybe soemone might want to include them in the article. I actually have over 50 of them taken at regular intervals over 15 months. In that aweful time, we learned that if your toe looks like the ones in any of these pictures: 1) it hurts - ALWAYS; 2) it does not fix itself; 3) it makes you limp; 3) you can't do anything like walk; 4) potions, lotions, creams, iodine, ispropyl alcohol, hydrogen peroxide, band aids, cotton stuffing, tissue paper, tweezers, clippers, probes, pokers, lifters, forceps and especially bathroom surgery are nothing but placebos and DO NOT WORK; 5) one cannot not outwait it - toenails take up to a year to grow and the nail does NOT 'grow past the problem'; 6) one WILL get sick from swallowing pain and vainly trying to ignore it away; 7) GO TO THE DOCTOR AND DO WHAT HE SAYS. That is exactly why the pictures need to be here! Capiche? DocEss 17:59, 29 August 2006 (UTC)

- I had my third operation on ingrown toenails. The first one was with local anasthesia and the surgeon *only* removed the nail with leaving the toematrix intact, which was bad since it grew in again a year later. I had a second operation gladly with full anasthesia (believe me! it is so unbearable painful! you can't compare it to anything else!) and the surgeon removed parts of the toenail (the sides) including the wounded tissue and parts of the matrix. AND IT WAS GOOD (well after a few weeks)! Now (four days ago) i had the same on the other toe. It didn't went as good as the 2nd time but after all I'm glad its done. My personal advice is, don't wait with surgery! you can't expect to go away by itself! the longer you wait the worse it gets! INSIST ON FULL ANASTHESIA!!! If the docter doesn't want to, go to another one!

[edit] Appropriate Voice?

Forgive me if I'm wrong, but various parts in this article seem too flippant and personal to me, in particular the line which reads "Wearing shoes/trainers which are too small, however fashionable or expensive they are, either in size, width..." - is the however fashionable or expensive really appropriate? I intepret this as quite a personal, potentially flippant remark. Could someone a little more qualified look into this, and if necessary clean up the in-appropriate parts?

Hi there. It's not really flippant, although I can see how it might appear so. Nearly all ingrowing toe-nails are caused by the wearing of inappropriate footwear; most of the rest are caused by the nails being cut too short and then being subjected to minor trauma. I operate on perhaps a hundred of these nails a year, the vast majority of patients being aged between 15 and 25. Fashion is, I am afraid, a major causative factor.--Anthony.bradbury 22:55, 11 August 2006 (UTC)

I was going to comment or edit a couple of points "(i.e. do not pick at them whilst watching TV)" but they made me smile, so I'm not going to personaly make any move to remove them. If someone does feel the need, more power to you. Elpha 19:47, 30 March 2006 (UTC)

[edit] Second Opinion?

I just very recently had the avulsion method performed, but my doctor gave me a little bit different information about it. He stated that if the nail is removed completely and allowed to grow back, it is more likely to grow back normally and without further issues than the wedge resection method. I can see various reasons why it might be less optimal of a procedure, but given the context of the situation, I think it might be more beneficial in the long run. I'll be able to formulate my personal opinion in 6 months, after the nail has a chance to grow back, but until then I'm trusting my doctor. --Skudd 04:53, 6 July 2006 (UTC)

Well done. Your doctor is quite right. Yes, I am medically qualified to make this comment.--Anthony.bradbury 22:57, 11 August 2006 (UTC)

[edit] Wedge resection

Just for the record, I do large numbers of these; they take perhaps five minutes to insert the local anaesthetic and wait for it to work, and perhaps two minutes to perform the procedure. Phenolisation to prevent regrowth of the edge of the nail takes a further three minutes. The use of a tourniquet causes excessive bleeding on its removal, and is wholly unnecessary. If any qualified person reads this, I urge you to dispense with the tourniquet; you will be delighted. So will your patient.--Anthony.bradbury 22:50, 11 August 2006 (UTC)

Actually, my brother had this procedure done with a touniquet. Here is a picture starting the day after surgery and ... gosh, ... there was a lot of bleeding. Hmmmm...

[edit] V in Toenail

ahh... the allmighty wikipedia states that cutting a V does nothing.

Student Health Services @ University of Iowa seems to disagree with you. http://uistudenthealth.com/question/default.asp?asgid=19&agid=4&id=565

Ah, they are wrong. Toe nails take so long to grow that a nip here and clip there are fruitless except for their placebo value. Nothing you do will work if your toe nail is truly ingrown. See above conversation.

I had a ingrown toenail that i had for two years before finally having the edge cut out today (out of ignorance). It took this long because i learnt off someone to use a nailfile to thin the top of the nail, this does help, causing much less pressure on the edges. Whether the nail shinks inwards (like the V-cut) i could not prove (but that was how it was described to work). Also my doctor always puts one stitch in the toe to pull the skin back to the nail, is that bizarre? HarmoniK 15:38, 28 August 2007 (UTC)

Harmonik--I had three doctors hack and saw on an ingrown nail over a two year period--complete removal of nail, partial removal, and cutting out two wedges of swollen tissue--to no avail. Then an old army nurse told me about thinning the center of the nail--I used a razor blade--and the problem was quickly solved. The same treatment has worked, usually in 48 hours, every time a nail has threatened to ingrow. The technique ought to be commented on in the main article. Jm546 21:20, 5 January 2007 (UTC)

I'll add it, feel free to finetune it anyone. HarmoniK 15:38, 28 August 2007 (UTC)

Please take digital picture and upload it. Thanks tons. Hope it feels better.DocEss 16:25, 18 October 2006 (UTC)

Simple logic, the article says that trimming the front edge of the nail straight across prevents ingrowth, yet calls cutting a "V" into the same edge does nothing. That doesn't wash. Either the front edge can't affect the sides, or it always does. —The preceding unsigned comment was added by 75.72.21.221 (talk) 23:19, 9 March 2007 (UTC).

[edit] History

Does anyone believe a section on the hitsory of ingrown toenails would be useful? Comments? Hey - do ya know what my brother's podiatrist said to me when I asked him how they treated ingrowns before anaesthetic? He said, "Whiskey and pliars." Yikes. DocEss 18:56, 6 September 2006 (UTC)

[edit] 'Problem of the West' phrase

I removed this comment because I cannot find a proper source. Moreover, I wonder if it is even relevant - it's almost trivial in nature, I think. Find a source and then we can put it back. "Ingrown toe nails are a problem of the West, and are virtually unknown in cultures that do not wear enclosed shoes^{[citation needed]}." DocEss 17:29, 14 September 2006 (UTC)

Anything to score points against "the big, bad West"! Talk about having a chip on your shoulder. 24.137.126.62 03:58, 8 December 2006 (UTC)

[edit] Unrelenting need for pain and pressure

Could anyone please expand on the statement about unrelenting need to suffer pain and pressure in the If Left Untreated section?? I'd like to know more about this particular symptom. Thanks. Rebel.crusader 22:32, 3 October 2006 (UTC)

Expand where, in the Article? In any event....Ingrown toenails are always painful: sometimes they hurt like hell, sometimes the just hurt a lot. But they never stop hurting and the victim is nearly always constantly aware of 'something to endure and suffer through' at the end of his foot. Chronic pain is a well-documented source of both physical and emotional stress, and this strees can manifest itself in inumerable symptoms.DocEss 16:20, 11 October 2006 (UTC)

--- Personal experience, ive just had to have a wedge resection today, the V shape cutting actually did nothing for me, a year of trying it and it made no difference, i still had to have the resection, it had too be performed in a hospital as GP's seem unwilling to do this sort of thing.

Wikipedia really does do wonders, eh? I've been to this article before to see about my problem, but my anxiety and, frankly fear, was a tad too overwhelming. A few bathroom surgeries left me hopeful, but those damned nails keep growing in - I've had two or three recurrences since I first noticed this ache in August (2005). The psychological part of this is (I think) in some cases perhaps comparable to the shame involved with cancer. Sometimes the toe doesn't hurt at all, at other times it's... well frankly hellish. I am trying to find a good orthopedian (or whatever you called'em), but in my state there aren't likely to be any. I'll find someone, though, and I'll tell them just what I feel of the V-clip. What I'd like to ask, since I'm here, is how long most of you guys (who have experienced it) have gone with your toes in this sorry state? I'd like to know just how I'm positioned, having experienced this for about half a year, maybe more. 81.93.102.185 14:07, 2 January 2007 (UTC)

'Guys' will wait for ever; women are smart enough to get it fixed when it hurts. Anyway, there is no hope of auto-recovery. Go to the podiatrist and have a partial matrixectomy completed. Or, you can just eat painkillers and soak your foot in the sink, playing with it regularly until in it gets so badly infected that the doctors hack off your toe/foot/leg. Maybe they should just cut off your head and be done with it. —The preceding unsigned comment was added by 142.59.9.52 (talk) 20:50, 4 May 2007 (UTC).

Damn feminazi. Go away.  OMGWTFBBQ  BLAH  00:58, 7 March 2008 (UTC)

Explain please. —Preceding unsigned comment added by 137.186.251.55 (talk) 19:45, 25 March 2008 (UTC)

[edit] From Personal Experience

I visited the doctor today for this problem.

To my surprise, he simply removed part of the nail that was thrusting in my flesh, cleaned off the blood and applied a wet bandage with salty water. He also prescribed oral antibiotics and asked that I hose the bandage with salty water every 4 hours for 2 days.

24.201.67.83 05:53, 23 June 2007 (UTC)

[edit] Any Difference?

I know what a wedge resection is, but does anyone know what a radical wedge resection is? I had it back in March on my toe, and it feels much better (except its happening on the opposite toe now).

[edit] "Going through the end of your shoes"

I see that this phrase is used twice in this page. Despite involvements with a variety of sports, I haven't heard this phrase before. When I Googled it the only hits that came back on the exact phrase (surrounded with quotes) were this page and someone copying this page's content.

I suggest that this phrase either be removed, cited, explained, or linked. Thoughts? —Preceding unsigned comment added by 75.17.112.14 (talk) 05:52, 27 October 2007 (UTC)

I should think common sense would inform you that the meaning "going throught the end of your shoes" is self-evident. But just for you......it means in this idiom: stopping too quickly and having the foot slide forcefully toward the end of the toebox of the shoe, thereby either jamming the toenial (usually the big toe) into the end of the shoe and setting up dreaded swelling & nail defromaties or else squishing the tender margin flesh into the nail and setting up inflammation. In any event, I can assure you from personal experience that this type of injury easily creates ingrowns, googlywoogly notwithstanding. —Preceding unsigned comment added by 142.59.9.52 (talk) 18:41, 6 November 2007 (UTC)

[edit] cut straight?

I never understood what this meant... Does it literally mean that I should cut my toenails so they're squared off at the end, with two sharp corners sticking out? Or is it referring to the cross-section of the trimmed nail? Because if you really expect me to make my toenails square, with the corners, I'll stick with the occasional ingrown nail. And how do you let it get this bad? With regular trimming, my toenail never goes beyond moderately-painful--and that's only if I let it get really bad. Then I trim it and pull out the offending ingrown part and it goes away. How long do you have to leave it to make it like those pictures? Yowza! I'm seriously confused here. --Buddy13 (talk) 11:05, 31 December 2007 (UTC)

It gets "this bad" when the tissue along the margin gets puntured or abrased by the nail. That little wound swells just like any wound and the swelling causes the flesh to press against that very nail. The nail acts as a constant irritant and the body reponds by trying to form a tough layer of skin to protect itself; this tough layer (hypergranualized) gets thicker and so further presses against the immovable nail, providing more swelling. The wound invariable gets a low grade infection and dishcarge occurs. At this point, you've got yourself a disgusting and agonizing ingrown toenail. Worse, the constant pressure from the swollen tissue will likely cause the nail to grow at a different angle --- this can cause the same problem on the other side of the nail! And it hurts. It's agony. Have you ever pulled out that little tage of skin along your fingernail? --- that hangnail? Hurts ya? Multiply by a hundred or so. Back to the point: cutting them rounded leaves a small and sharp little piece of nail at the margin (which is where the nail meets the flesh down below where you can see). This teeny little wound is the bad guy that slowly and surely causes all the trouble. So one must cut the nails in such a way that no sharp little edges can cause trauma to the flesh. Your claim that you sometimes get them to the point of being 'moderately painful' is as scary as it is interesting --- what you actually have there is a very fine line between having a nail pressing slightly into the flesh (causing some warning pain) and the nail being just about ready to puncture the flesh (causing months of agony and denial). I'd be careful about my trimming habits if I were you. Still confused? --137.186.251.55 (talk) 21:12, 24 January 2008 (UTC)

Thank you. --Buddy13 (talk) 01:25, 4 February 2008 (UTC)

Cutting the nail straight across is almost impossible to maintain, the new 'corners' are attached to nothing (the nail bed itself is curved just like the end of the toe) so they break off if you so much as look at them. What's more, those corners can injure you when they break, leading to an even worse infection (happened to me). Also, all this talk about going to a podiatrist doesn't take into account that most people can't afford health care. —Preceding unsigned comment added by 64.122.63.142 (talk) 21:22, 5 February 2008 (UTC)

You're undoubtedly referring to a toenail that has been allowed to grow too long. You must be sensible instead of extreme: too long is sometimes as bad as too short. Look at your thumbnail --- you wouldn't cut it back so that you couldn't see the leading edge, would you? Imagine the toenail from the side view --- the toenail is convex, not flat, and so when one 'cuts it rounded' he invariable leaves a sharp little edge where the nail is attahed to the flesh down in the margin. This is to be avoided like the plague! Allow the nail to grow so that it cannot dig into the flesh. As for health care costs, that is neither ther nor there. If people cannot afford necessary health care then they will either have to revise their health care systems through political action or they'll have to suffer with sore toes, infections, emergency surgeries...maybe even death. I'd suggest to those who can't afford proper health care that they take proper care of their nails and learn to cut them correctly.--137.186.251.55 (talk) 18:54, 6 February 2008 (UTC)

[edit] An addition to Causes

I think it should be added, that another possible cause of an ingrown toenail, is from trying to stablize yourself on a thrill ride by pushing the front of your foot into the car. I hope I'm explaining it right, if you feel you're going side to side too much there's a tendancy, to want to keep upright by using your foot. I want to make sure people know not to do this. I now have a reccuring ingrown toenail, cause I tried to do that on a roller coaster, and ended up hitting my toenail on the side causing a bruise. I think it must've messed up my nailbed, causing the ingrown toenail. Violet yoshi (talk) 00:30, 13 January 2008 (UTC)

You've "gone through the end of your shoes," ya poor bastard. If you've got an ingrown toenial, make an appointment to go to a podiatrist as soon as you stop reading this paragraph. Your problem will not fix itself. Godspeed, little buddy.--137.186.251.55 (talk) 20:22, 24 January 2008 (UTC)

[edit] This article is horrible

Can't someone PLEASE put a HIDE option on this picture?? I can't read the article!! --Nathanael Bar-Aur L. (talk) 01:02, 17 January 2008 (UTC)

Hey - horrid pictures are required in this article because they induce the afflicted to go to podiatrists. Just read all the commentary above --- people just don't get it! Pictures say a thousand words, ya?--137.186.251.55 (talk) 20:23, 24 January 2008 (UTC)

[edit] Silver Nitrate

The section on treatments doesn't seem to mention anything on the use of silver nitrate to remove hypergranulation tissue. Since I don't really know how this works and why it's used, perhaps someone medically educated could add this. Is this technique not used in treatments in the US, perhaps? It's the usual treatment here. —Preceding unsigned comment added by Hail True Body (talk • contribs) 23:14, 19 January 2008 (UTC)

"Here"? Where's "here"? Is that the UK? Judging from your teeeth it's no wonder your nail treatments are arcane too. Anyway....Silver nitrate has a low rate of success. Its efficacy is based on the pricicple that the AgNO3 forms a scar tissue under the offending piece of nail; this hardened tissue might --- just might in mild cases --- allow the hypergranulated tissue underneath to repair itself, lower the swelling and allow the nail to grow along at its glacial pace. This hardened tissue is sometimes hard enough to prevent further puncturing of the margin tissue. In fact, this is exactly what the body is trying to do for itself when it forms the hypergranulated cells in the first place --- it is trying to harden up the tissue, much like when calluses form after repeated blisters. The problems are that ingrown toenails often display irregular nail growth and the tissue repair mechanisms of the body just can't keep up with the constant trauma that the nail causes to the tender tissue. Again, the best and well-recognised solution is partial avulsion by way of phenolisation --- this procedure stops the naughty nail from cutting, pressing and digging and is simple in scope.--137.186.251.55 (talk) 20:50, 24 January 2008 (UTC)

I was advised to use Silver Nitrate by a Podiatrist in the UK and can't say it was useful. It was also quite painful for me, as it frequently is for people with red hair. 212.159.118.191 (talk) 22:16, 11 May 2008 (UTC)

[edit] How does that work?

If cutting a 'v' does nothing, how come rounding the end is apparently negative and cutting the end straight across is positive? Obviously doing something to the end of the nail does something. I'd like to know what mechanisms are behind that.. usually cutting into dead tissue shouldn't change anything. —Preceding unsigned comment added by 75.72.21.221 (talk) 05:18, 9 February 2008 (UTC)

V-cuts do nothing except trick the victim into thinking he's done something useful. The nail is not alive and cutting it longitudinally won't alter the growth of the remaing part. Please review above for commentary regarding 'rounding off the nails' --- the culprit is the little sharp corner that certainly remains (i.e. unavoidably remains) where the nail attaches to the nail plate at the margin, which is below where you can see.--137.186.251.55 (talk) 18:11, 18 February 2008 (UTC)

[edit] Phenolisation and Wedge Resection

Am I missing something or are these two sections essentially describing the same procedure? If so, should they be merged? Woood (talk) 02:11, 10 March 2008 (UTC)

You are missing something and the description should not be merged. They are not the same procedure, though one procedures uses the other procedure. Any nail can be cut back deeply along the margin in an attempt to relieve pressure; this cut is usually wedge-shaped and is called a wedge resection, which incidentally is an avuslion technique. Phenolisation is a word used to describe the ablation (i.e., destruction) of tissue, in this case the germinal matrix --- the matrix is where the body creates new nail; phenol (carbolic acid) is used to permananetly kill cells that create new nail. In the phenolisation ablation procedure, it is nearly always necessaary to perform a wedge resection to avulse the nail out of the way so that the phenol can be properly applied to the matrix. The purpose of both procedures is to relieve the pressure and irritation caused by mal-growth of the perioncyhium or by injury. With resection the offending nail usually grows back and re-offends; with phenol avulsion, it does not grow back and so cannot re-offend.--137.186.138.170 (talk) 19:20, 10 March 2008 (UTC)

[edit] "If Left Untreated" section

The If Left Untreated section is just too extreme. It should be pointed out that some ingrown nails simply heal themselves. I've noticed that medical articles and books tend to describe the worst-case scenarios, and you end up with a text which gives a lopsided view, scares the reader, and essentially imparts negative suggestions to the reader that his condition will get worse (and the power of suggestion has been shown to be considerable in the area of health). Someone needs to tone down the article a little.--Caleb Murdock (talk) 07:08, 13 April 2008 (UTC)