If You Think You Have an Ingrown Toenail On the Outside of Your Little Toe…..You May Be Wrong

little toenail

Many people experience discomfort and hardness to the outside of the little toenail, and assume it is because of an ingrown toenail or a hang nail.  They trim the nail back at this side, and maybe even have their doctor remove the side of the nail, but the problem seems to keep coming back.  Why does this keep happening, and what can be done to fix it?

The truth of the matter is that the little toe nail rarely develops what can be traditionally considered an ingrown toenail, and any treatment designed to treat an ingrown nail will fail because the underlying problem, in most cases, is something completely different.  A common thread in these situations is the shape of the little toe itself.  Most people in this situation have little toes that are either contracted (crooked), rotate outward toward the outer side of the foot, or are both.  As the toe skin on the outer side of the toe is thinner than the skin on the bottom, any prominence of the side against one’s shoe or rotation of this side towards the bottom exposes the skin on the side of the toe and nail to pressure it otherwise would not have to withstand.  As a result, the toe skin next to the nail develops a callus to protect itself from such pressure.  Since callus and nail tissue are virtually the same, it can be hard to distinguish this callus from the side of the nail, and it often is erroneously assumed this tissue is part of an ingrown toenail.

When one has an ingrown toenail procedure to remove the outer side of the little toenail, the only result is that there is now a broader space for the callus to spread, fooling people into thinking the ‘ingrown’ toenail has returned.  What needs to be done to treat this condition permanently is something a little more elaborate.  Simple solutions to reduce the outer pressure can be helpful for some, and can include wider and deeper shoes, padding to the outside of the toe (gel and elastic sleeve padding works nicely), or gentle regular filing of the callus that forms.  For long term relief, the abnormal position of the toe must be corrected to reduce the pressure.  This comes in the form of minor surgery, in which the toe contracture needs to be corrected, and  any rotation needs to be reversed to bring the little toe back into a straighter position.  These procedures heal relatively quickly, within a few weeks, and result in reversal of the abnormal callus and the pain that follows it.  Some people have a condition along with this called a Tailor’s bunion, in which the bone below the base of the little toe is prominent towards the outside of the foot.  This prominence has an effect on the position of the little toe, and in some cases needs to be corrected at the same time.  While this leads to a little longer of a recovery period, the results are typically far better than if just addressing the toe itself when a Tailor’s bunion is present.

Because this condition is often misdiagnosed as an ingrown toenail, it is important one see a foot specialist, who will be better trained to recognize the structural factors that lead to its development and can treat it properly while avoiding nail procedures that won’t actually fix the problem.

What Can Be Done About A Thick and Painful Toenail?

thick toenails

Many people are surprised to find out that toenails are relatively fragile appendages of the body. Toenails can take a mild amount of abuse from tight shoe pressure, years of toe stubbing or objects dropping on them, damage from jogging and exercise, or changes due to chronic fungus infections. Over time though, the nail root cells that produce the nail plate itself will become damaged, and they will begin to permanently produce nail that is thick, deformed, often painful, and even severely ingrown on one or both sides. As a result, many people find themselves with one or several toenails that hurt with shoe pressure, or anything pushing on the nail (like bed sheets). Unfortunately, these changes are permanent. In the case of nail fungus, it is assumed medication can ‘cure’ the disease. While it is true anti fungal medication can kill fungus in some cases, once the nail reaches a certain point of damage, there is no restoring the nail back to normal.

Treating these painful and deformed nails can be fairly simple. There are topical medications designed to soften the nail and help make it thinner, but unfortunately these typically are ineffective on thicker toenails, and treatment has to be performed for life. A pedicurist or podiatrist can grind the nails down to make them thinner, but this has to be repeated frequently as such nails typically thicken again within a couple of months. A better, and more permanent, option is to simply remove the toenail for good. Many people seem initially put off by the concept of this procedure. Once one realizes the ease of the procedure and its recovery, the fact that under the nail is normal skin that is not cosmetically disfigured without the nail on top, and the fact that there will be no further pain from the nail, the procedure itself becomes a sensible and preferred option.

Removing a toenail is not difficult matter, and for most people the procedure is relatively painless outside of the brief discomfort of the shot needed to numb the toe. The entire procedure including the numbing period is performed in under 15 minutes in an office setting. Once the toe is numb, the problematic nail is easily removed and a chemical is used to kill the nail root cells so no more nail is ever produced in that toe. Called a ‘phenol matrixectomy’, this procedure has been performed for about a hundred years and has great results. The recovery is brief, usually lasting 2-3 weeks and there is no restrictions on activity or shoe use. Most people have no discomfort during recovery, and go about their normal day unaffected by the procedure. The nail bed skin that remains on top of the toe can even be polished to match intact toenails next to it, with no one being the wiser that the nail is gone.

Such a procedure is perfect for those with one or a few painful deformed nails, and is nearly always covered by insurance. I have performed many thousands of these procedures. In nearly every case my patients have confided with me they wished they knew it would have been that easy to get relief years earlier, as they would not have otherwise suffered with a painful nail for so long.

If you have this same problem, be sure to call your local podiatrist to discuss how removing the painful and deformed toenail permanently can lead to relief.

I Felt A Sharp Pain With A Snap In My Arch When I Stepped Down and Now I Can’t Walk

painful heel

Some of the most frequent foot injuries I see involve the heel and arch.  A number of different injures can cause pain in this part of the foot, including muscle and tendon strains.  However, one structure by far sees the most number of injuries in this region:  the plantar fascia.  The plantar fascia is a stout ligament that runs along the bottom of the foot  Typically it is injured over time, often as a result of strain and inflammation  to the fibers from abnormal foot structure, poorly supportive shoes, or repetitive activities like climbing up and down ladders.  This type of pain has a more gradual onset, and is known as plantar fasciitis.  However, when the pain is sudden, and accompanied by a mis-step as well as a tearing or snapping sensation, the injury is often more severe, and involves a partial tearing of the fascia.  As fasciitis and a tear are treated quite differently, prompt diagnosis and proper treatment can make the difference between a relatively short recovery period and a prolonged done.

The plantar fascia tear, or rupture as it is commonly known, can occur when a foot is planted on the ground firmly at the base of the toes, causing a sudden stretching of the plantar fascia beyond its limit to stretch.  This can also occur when the foot is suddenly flexed upward by force, or when stepping on an object like a root or the broad edge of a rock while barefoot or in poorly supportive shoes or sandals, in which a specific part of the fascia is forced upward suddenly.  The symptoms can include a sudden sharp or burning sensation, accompanied by a sensation of tearing or snapping.  For most, it is extremely difficult to bear weight.  The fascia tissue usually only tears partially, with most of its substance remaining intact.  However, this smaller part that is torn can create a significant amount of pain.  Often felt in a specific location in the arch or heel, the pain can eventually expand to include a broader area.

Treatment of plantar fascia tears requires immediate immobilization of the foot to reduce forces that load onto the plantar fascia when walking, and permit the tissue to heal.  The mainstay of my treatment includes the use of a pneumatic walking boot to displace the forces of walking, as the shape of the bottom of the boot is that of a rigid rocker bottom design, which helps the foot roll over the ground without bending.  Severe cases of plantar fascia tears do require further immobilization in a below knee cast and non- weight bearing, although most people do just fine in the walking boot.  It is typical for the fascia to take four weeks to heal, although some people can have prolonged discomfort for another month or two.  If this injury is not treated and left to heal on its own, the time for healing could extend into months and years, as the development of inflammatory plantar fasciitis becomes inevitable at that point.

If you suddenly feel pain in the heel or arch after stepping oddly (especially with a tearing or snapping sensation), and the pain does not go away within a day or two, it is a good idea to see your local foot specialist for immediate care (or see me if you are in the central Indiana region).  This could make the difference between a quick recovery and a protracted one.

Do I Need To See A Doctor For My Anke Sprain?

sprained ankle

Ankle sprains are one of the most common injuries that occur in the body.  Athletes playing sports make up part of the millions of people each year who sprain their ankle, as well as people simply walking on uneven ground, stepping into a hole, slipping on ice, or awkwardly stepping off of a curb.  Ankle sprains can run the range from simple to severe, with some sprains feeling fine after a few days to others with pain lasting well over a month.  Ankle sprains are one of the most under treated types of foot and ankle injuries, and these seemingly simple injuries can often have long term effects on the health, function, and stability of the ankle as a whole.

An ankle can be injured when it rolls either inward or outward.  The ankle is bound together on either side by strong straps of tissue called ligaments.  The ligaments on the inner side of the ankle are particularly strong, and rarely get injured.  The ligaments on the outer side of the ankle are considerably weaker, and therefore it is easier for the foot to roll inward under the ankle during an injury, which then cause the outer ligaments to either stretch or tear.  There are three total ligaments on the outer side of the ankle, and the severity of the sprained is defined by how many ligaments were injured, and whether there was simply a stretching of the tissue or an outright tear.  Whether stretched or torn, an ankle sprain can pave the way for future sprains to more easily occur because of the looseness of the tissue that follows such injuries.  While tears are certainly more unstably, stretch injuries can also lead to ‘loose ankles’ that have a higher chance of re-injury, and even an elevated chance of that injury causing a fracture in the ankle.  Unfortunately, even simple sprains can also have additional injures dealt to the foot by the force of the sprain injury, which may go unrecognized or mixed in with the pain of the sprain itself.  These can include muscle strains in the leg or foot, sprains of smaller joints in the foot, microscopic fractures in bone, nerve stretching injuries, and tendon strains.  It is not uncommon for these additional injuries to be missed even in an emergency room, where sprain care is basic and concentrated on making sure a fracture is not present.  These additional injuries may be subtle at first or simply painful with the sprain, but over time can gradually lead to secondary areas of pain, further foot or ankle instability, arthritis, weakness, or loss of some sensation (if a nerve was damaged).

Because of the long term implications of ankle sprains and their associated secondary injuries, it is recommended sprains be evaluated by a physician, with a strong preference towards a foot and ankle specialist well trained to recognize all the subtle elements that make up these injuries.  Early appropriate treatment can be vital to ensuring the ankle passes through the injury period intact and healthy.  Examples of early intervention includes stable ankle bracing, early therapy and mobility exercises, as well as a guided return back to activity.  this level of treatment can make a world of difference between an ankle that stays healthy and strong, and one that becomes chronically weak.  As the after-effects of a sprain may take years to fully appear, the notion of being ‘tough’ and ignoring the sprain in the hope it will simply heal on its own is unwise, especially when professional care for these injuries is so easily available.