Persistent Ingrown Toenail: Seeking Effective Solutions for Relief

Onychitis keeps recurring?

I have been suffering from paronychia on my right big toe.
It used to heal in a few days, but two years ago, the pain became unbearable, so I went to see a doctor.
The doctor said it was due to cutting the nail too short.
I then visited two more doctors, and they all said it would get better.
They trimmed almost one-fifth of the nail from the inner side where the paronychia was located, but when the nail grew back, it just grew into the flesh, which should not be related to how I cut it.
Each of the three doctor visits was increasingly painful, especially while waiting for the nail to grow back...
but it keeps recurring! Even a light touch causes significant pain, and now I feel uncomfortable even walking or running...
However, no one has mentioned any pus! Is it possible to completely cure this? The doctors say it will get better, but it hasn’t.
Is there a method that can truly resolve this? I don’t want to live with this pain for the rest of my life!

Tai Le, 10~19 year old female. Ask Date: 2012/08/31

Dr. Lu Daokuan reply Plastic Surgery

For paronychia, it is important to avoid wearing tight shoes.
After partial nail removal, the wound should be secured with tape for four weeks to prevent the nail from growing downwards again.
If the condition recurs after 2-3 excisions, it is recommended to perform a nail bed matrixectomy.

Reply Date: 2012/08/31

More Info

Persistent ingrown toenails, or onychocryptosis, can be a frustrating and painful condition that significantly impacts daily activities. Your experience with recurrent ingrown toenails, especially after multiple visits to different doctors, is not uncommon. The condition often arises when the nail grows into the surrounding skin, leading to inflammation, pain, and sometimes infection.

Understanding Ingrown Toenails
Ingrown toenails can occur for various reasons, including improper nail trimming (cutting the nails too short or rounding the edges), wearing tight footwear, or having naturally curved nails. In your case, it seems that despite attempts to manage the condition through nail trimming, the problem persists, indicating that there may be underlying factors contributing to the recurrence.

Treatment Options
1. Conservative Management: Initially, conservative measures can be attempted. This includes soaking the affected foot in warm, soapy water to reduce swelling and pain, followed by gently lifting the ingrown edge of the nail away from the skin. This can be done with a small piece of cotton or dental floss placed under the nail edge. However, this method may provide only temporary relief.

2. Proper Nail Trimming: It’s crucial to trim your nails straight across and avoid cutting them too short or rounding the edges. This helps prevent the nail from growing into the skin.

3. Footwear Choices: Wearing shoes that provide ample room for your toes can alleviate pressure on the toenails. Avoid tight shoes or high heels that can exacerbate the condition.

4. Medical Interventions: If conservative measures fail, medical intervention may be necessary. Options include:
- Partial Nail Avulsion: This procedure involves the surgical removal of the portion of the nail that is ingrown. It is often performed under local anesthesia and can provide significant relief.

- Matrixectomy: In cases of severe or recurrent ingrown toenails, a matrixectomy may be performed. This involves removing the nail matrix (the tissue that produces the nail) to prevent the nail from growing back in that area. This is a more permanent solution and can effectively prevent recurrence.

- Antibiotics: If there is any sign of infection, your doctor may prescribe antibiotics to treat the infection and reduce inflammation.

5. Follow-Up Care: After any surgical intervention, follow-up care is essential. Keeping the area clean and dry, and following your doctor’s post-operative instructions can help ensure proper healing and prevent recurrence.

Seeking Specialist Care
Given your ongoing issues, it may be beneficial to seek care from a podiatrist, a specialist in foot and ankle conditions. They can provide a thorough evaluation and recommend the most appropriate treatment plan tailored to your specific situation.

Conclusion
While ingrown toenails can be persistent and painful, effective treatments are available. It is essential to address the underlying causes and consider surgical options if conservative measures do not provide relief. With the right approach, you can find a solution that alleviates your pain and allows you to return to your normal activities without discomfort. Remember, it’s important to communicate openly with your healthcare provider about your concerns and the impact this condition has on your quality of life.

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