Posts for category: Dermatology
Ingrown toenail surgery that we perform in our offices do not require STITCHES and most people experience LITTLE, if any, pain, and NO TIME OFF WORK when these instructions are followed:
1. Keep the foot clean and dry and leave the dressing on for one day.
2. Minor bleeding is normal and can be controlled by elevating the foot or applying ice to the area. Do not remove the dressing if it bleeds; apply additional gauze instead.
3. The anesthesia will wear off in 1-2 hours. Most people require no pain medication at all, but Tylenol, Aspirin or Ibuprofen work well when needed.
4a. The day after surgery, begin soaking your foot according to the following (if not a permanent nail procedure with chemical)
- Prepare soaking solution by dissolving 1 tbsp. of table or Epsom salt per pint of warm water.
- Soak your foot for 10 to 15 minutes once a day for two weeks.
- After soaking, remove the bandage, pat dry and apply 1-2 drops of the antibiotic solution prescribed into the groove where the nail was removed.
- Replace the previous dressing with a Band Aid.
4b. If using Amerigel wound kit (For permanent nail procedure with chemical) simply apply Amerigel medication to Band Aid and change daily for two to three weeks.
5. Some drainage from the nail surgery site is normal and desirable because this is the way the body rids itself of the toenail "root cells" that we killed. Moderate redness around the nail surgery site is also normal unless the amount of redness increases dramatically.
6. In approximately 5% of patients or less, the nail will grow back or continue to curl. If that happens, a repeat procedure is usually done.
Patients that are involved in walking, running, or athletic activity can typically return to activity within 2-3 days for removal of infected toenail and 5-7 days for a permanent nail procedure with chemical application.
One of the most common foot conditions that we see in our practice in adults and children are ingrown toenails. An ingrown toenail most commonly affects the big toe, known anatomically as the Hallux. When an ingrown toenail occurs, the nail grows abnormally into the skin and flesh of the toe. This leads to pain and the overgrowth of skin tissue at the side of the nail.
Sometimes the edge of the toenail pierces the skin outside of the nail groove, beginning to act as a foreign body. Sometimes a nail is ingrown not only at the corner of the nail plate, but all the way down. The first signs of either condition are pain and swelling. The area of penetration may bleed or become infected, producing pus.
Causes of an Ingrown Toenail?
The condition is caused by any of several factors. The most common of which is probably improper nail trimming, cutting the nail too much, so that when it begins to grow back it grows out of the “nail groove” directly into the flesh of the toe.
In addition, some people are hereditarily predisposed to developing the condition.
Symptoms of an Ingrown Toenail?
Severe pain, infection, swelling, sometimes pus, are major symptoms of the condition. It is normally obvious with a visual inspection, which will show that the nail is in fact growing into the skin and flesh of the toe, and that an infection is present.
Treatment for Ingrown Toenail?
If you have an ingrown toenail, it is best to see your foot specialists for advice. Any toenail that is bleeding, excreting pus, or swollen should be examined by a doctor. Many people with ingrown toenails delay treatment, or make matters worse by resorting to home remedies that may be more painful than medical attention.
Painless Surgery for an Ingrown Toenail?
If the condition has resulted in permanent overgrowth of the tissue surrounding the nail margin, or in recurring infection, surgery may be required to treat the condition. Surgical treatment varies slightly depending on the particulars of each individual case.
In mild cases, removal of a portion of the tissue at the side of the nail groove may reduce pressure and irritation. In this procedure a wedge of tissue is removed and the healing process allows the groove to reform itself.
Sometimes surgery involves use of a local anesthetic and removal of a portion of the toenail and its root. Patients with recurrent ingrown nails may require the use of a medication known as liquid phenol, which permanently removes lateral portions of the nail matrix
In our practice we use a topical anesthestic before the injection called Ethly Chloride which freezes the skin to make patient's more comfortable.
Surgery for ingrown toenail is painless and easy to perform in the office setting. Patients should be able to put weight on their feet immediately after surgery but walking is uncomfortable. In most cases, toenails grow normally after surgery without imbedding themselves into the skin.
It is important to carefully follow instructions before and after any surgical procedure in order to have the best results and quicker recovery time. Changing the style of footwear you use is very important such as wearing a wider toe box shoe.
Onychomycosis (Fungal toenails) is a common complaint that we see in our practice. There are many ways to contract this condition. Pedicures, trauma to the toenails, and feet that constantly sweat are the more common causes. We offer many conservative treatment options for fungal infected toenails. In our practice we are able to diagnose this condition either through a biopsy of the toenails and/or clinical evaluation.
The toenails typically will have a yellow, thick appearance that makes it difficult to trim. This condition can progress at a fast pace if not diagnosed and treated promptly. We offer conservative treatment such as professional nail debridment, filing, topical antifungal treatment, and for certain more advanced cases oral Lamisl three month course. Our practice is investigating new state of the art options such as laser treatment for fungal infected toenails.
If you feel like you may have a fungal infection of your toenails please contact our office at carolinafootspecialists.net
Don't Let Your Feet Ruin Your Day at the Beach
As you head to the beach this summer we wanted to discuss some common injuries to look out for and some simple preventative treatments that you can utilize.
Puncture wounds and cuts: Wear shoes to protect your feet from puncture wounds and cuts caused by sea shells, broken glass and other sharp objects. Don't go in the water if your skin gets cut - bacteria in oceans and lakes can cause infection. To avoid complications from a puncture wound, see a foot and ankle surgeon for treatment within 24 hours.
Jellyfish stings: Remember that a jellyfish washed up on the beach can still sting if you step on it. If their tentacles stick to the foot or ankle, remove them, but protect your hands from getting stung too. Vinegar, meat tenderizer or baking soda reduce pain and swelling. Most jellyfish stings heal within days, but if they don't, medical treatment is required.
Sunburns: Feet get sunburn too. Rare but deadly skin cancers can occur on the foot. Don't forget to apply sunscreen to the tops and bottoms of your feet.
Burns: Sand, sidewalks and paved surfaces get hot in the summer sun. Wear shoes to protect your soles from getting burned, especially if you have diabetes.
Ankle injuries, arch and heel pain: Walking, jogging and playing sports on soft, uneven surfaces like sand frequently leads to arch pain, heel pain, ankle sprains and other injuries. Athletic shoes provide the heel cushioning and arch support that flip-flops and sandals lack. If injuries occur, use rest, ice, compression and elevation to ease pain and swelling. Any injury that does not resolve within a few days should be examined by a foot and ankle surgeon.
Diabetes risks: The 20 million Americans with diabetes face serious foot safety risks at the beach. The disease causes poor blood circulation and numbness in the feet. A diabetic may not feel pain from a cut, puncture wound or burn. Any type of skin break on a diabetic foot has the potential to get infected and ulcerate if it isn't noticed right away. Diabetics should always wear shoes to the beach, and remove them regularly to check for foreign objects like sand and shells that can cause sores, ulcers and infections.
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