If you have a 'partial nail avulsion'...

[AJMD429]

This is what it will look like...

Toe Surgery Fun.jpg

...done bunches of them on patients (for 'ingrown nails') and it makes them quit the repeated infections and chronic pain, but never did one on myself. My NP wanted to learn how to do them, so I helped her do mine. The only 'hard part' is the "digital block" which numbs the entire toe; kind of like when the dentist numbs your gums before working on a tooth.

Doctors should all have to be patients now and again; it keeps us more aware of what it's like on 'the other side'...

[Old Ironsights]

Hmmm... Why is it that when I do that to myself for my chronic ingrown toenails they continue to ingrow? (No digital block, just some lidocaine gel...)

[AJMD429]

The digital block enables you to cut back under the proximal skin, splitting the nail all the way to the matrix (where it grows from) which is about 3/8" proximal to the normally-visible parts of the nail. You also have to use a mini-chisel to separate the nail from the skin underneath. THEN you must use something (we use phenol) to kill the matrix cells so there is no re-growth. That would probably be intolerably painful without a digital block first; kind of like pouring gasoline in an open wound.

[Old Ironsights]

The digital block enables you to cut back under the proximal skin, splitting the nail all the way to the matrix (where it grows from) which is about 3/8" proximal to the normally-visible parts of the nail. You also have to use a mini-chisel to separate the nail from the skin underneath. THEN you must use something (we use phenol) to kill the matrix cells so there is no re-growth. That would probably be intolerably painful without a digital block first; kind of like pouring gasoline in an open wound.

Ah. So while I've been successful in splitting the nail and separating the split nail part from the bed, I'm just not excising enough to get to the matrix, and I definately haven't been killing the matrix in the ingrowing area. Makes sense.

Well, next time I'm in Indy I'll have you put the bamboo under my toenails, OK?

[Griff]

Doc, if you're going to post pictures of your toes, include a levergun and wear slippers!

[Chuck 100 yd]

Griff, Just what I was thinking also.
I had ingrown toenails as a kid and I quit cutting on them and let them grow out cutting their way right through the skin. A very painful month or more but 50+ years later they are still good.

I had tonsil problems about that same time and I know the doctor was giving me Penicillin for that so I never really had any BAD infection issues with my big toes.

[Blaine]

Heck, I just grab a hunk of nail and pull back on it until it comes out....liberally dose with IPA, and wrap with a bandaid......

[pwl44m]

It is much simpler and a whole lot less painful. Take medication for fungus and get rid of it. My first go around I was prescribed some kind of antifungal, which required a blood test to make sure My Kidneys were Ok. Then took a regimen of medication and it went away. My Doc said it would probably come back in a couple years and sure enough it did. That was with a Dermatologist. Some years later another Dr. prescribed (Lamosil - I think). from what I remember I took it for 30 days and haven't had a case since. That was over 10 years ago. My Doc explained it as Not being an ingrown Toenail but Fungus building up underneath the nail causing excruciating pain. Doc correct Me if I'm wrong on this but it worked for Me.
Perry

[AJMD429]

Griff, Just what I was thinking also.
I had ingrown toenails as a kid and I quit cutting on them and let them grow out cutting their way right through the skin. A very painful month or more but 50+ years later they are still good.

I had tonsil problems about that same time and I know the doctor was giving me Penicillin for that so I never really had any BAD infection issues with my big toes.

This one would have NEVER grown through the tip like you're talking about, (I'd let it go two years to see if it would), but you are right in that they usually WILL do that if you're patient. I also had an abscessed tooth last week so as you noted, the antibiotics (three 500mg Keflex plus one 875mg Augmentin, twice a day) chilled out BOTH infections pretty well.

Doc, if you're going to post pictures of your toes, include a levergun and wear slippers!

Gosh, I should definitely have done that - kind of a "Reverse YK" format...

Toe Surgery with Rossi.jpg

My Doc explained it as Not being an ingrown Toenail but Fungus building up underneath the nail causing excruciating pain. Doc correct Me if I'm wrong on this but it worked for Me.

What I had was VERY ingrown, and no fungus (the nail went 9mm off to the side with a pointy 'plow-tip' digging into the medial part of the toe), so it HAD to be cut out.

However, you ARE right that many of the nail problems we see are caused by fungus, and it can eventually be eliminated. Pros and cons to oral antifungals vs. topicals, but can be treated, if you keep at it long enough.

[Griff]

Glad you got it taken care of. Hope you have a good nurse to make sure it's properly bandaged, etc.!

[pwl44m]

I can sympathize with anyone that has this problem. My Wife went to the Doc to have Hers checked out (several years ago) and came home Sans Toenails. No prob since. She paints the Toe as if it were a Nail.
Perry

[AJMD429]

Glad you got it taken care of. Hope you have a good nurse to make sure it's properly bandaged, etc.!

Already told my wife I'll need a couple weeks of rest, and her to tend to me. Started off watching "Machinegun Preacher" today, and figured maybe ten days of staying at home watching cool movies and having her bring me food and drink would make me get back to normal sooner.

....then the fight started...

[Sixgun]

Doc,
Thanks for the neat picture. It went very well with my coffee and egg sandwich here in the shipping office. The guys here said you have sweet looking toes and are interested in your phone number. -----------------6

[piller]

Doc, with my toenails that look like the capital letter C, but squeezed in a little on the sides, I probably need to have done what you had done, but mine don't bother me.

[Chris83716]

I did it myself like O.I. and it hurt less than the thing being ingrown. Hopefully it grows back "right".

Chris

[92&94]

They did that to me as a teen. The shot between the toes was absolutely horrible

Darn nail became ingrown when it grew back too, but the procedure did give me a respite from the chronic infection.

Finally my grandfather showed up for a visit and worked his more old school magic (he was an MD). Iced it thoroughly, then pried up the ingrown part with small scissors and stuffed cotton underneath to hold it up. That worked really well and was less painful than the shot between the toes. Only trick was to keep the cotton changed so it didn't get nasty.

The problem never really went away fully until I started wearing boots all day - boot makers still understand wide feet and make EE sizes. The sneakers I wore as a kid were always too narrow.

[1894c]

OUCH... :O