Nov 9, 2009 9:23 am US/Eastern
Dr. Mallika's Files: How Not To Cut Your Toenails
Each week Dr. Mallika Marshall shares cases based on true stories from a local urgent care clinic, exclusively on wbztv.com. Names and identifiable characteristics of patients have been omitted or changed to protect patient privacy.
This Week's Case:
A 33-year-old woman comes to clinic complaining of pain in her right big toe.
She says she developed pain along her right big toenail about a week ago and now it's red and throbbing. She denies any trauma to the toe but remembers cutting her toenails with nail clippers about two weeks. She has not had a recent pedicure. She has never had this problem before. She has not had a fever. She is taking Tylenol without relief.
"It hurts to walk or to put my shoe on."
On exam, there is redness and swelling along the outer edge of the right great toenail where it appears the nail has grown into the neighboring skin. The area is exquisitely tender to touch. There is no discharge.
Discussion:
This patient suffered from a very common ailment: an ingrown toenail.
It often occurs when a patient trims her toenails too low and/or trims off the corners, allowing the nail to get wedged under the skin when it grows back. An ingrown toenail can also result after stubbing the toe or from wearing shoes that are too tight or ill-fitting. The big (or great) toe is the most common toe involved.
Pain around the corner or edge of the toenail is the first symptom. The toe may then become red and swollen and if it gets infected, may drain pus.
You can try to treat an ingrown toenail at home by soaking the toe in warm water several times a day. You can also try to gently lift the corner of the nail with a pair of tweezers and place a small piece of cotton under it. Change the cotton every day and wear open-toed shoes. You can also apply an antibiotic ointment to the area to try to prevent infection.
If the condition worsens or you think the area is becoming infected, you need to will need to see a medical professional who may need to remove all or part of the toenail. You may also need to take an antibiotic and pain medication.
To try to prevent an ingrown toenail in the first place, when cutting your toenails, cut the nail straight across and not too low. Always wear comfortable shoes. And if you have diabetes or problems with circulation, be very careful about how you care for your nails. You may need to have them trimmed by a podiatrist.
Follow-up:
The patient's toe was numbed with a local anesthetic. Using special instruments, the ingrown toenail edge was cut and removed. A dressing with an antibiotic ointment was applied.
There was little evidence of infection so an oral antibiotic was not prescribed. The patient returned in two days for a recheck and was feeling much better. She was instructed on how to cut her nails in the future.
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