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Sunday, September 16, 2012
Ingrown Toenail: Email Advice to a Friend
Hi Rich – Hope all is well with you. I need a professional favor. I hurt my toe and need to know if I should come see you or if it will get better on it’s own.
Here’s the deal – about 2 weeks ago I went running in shoes slightly too small in the toe box and the big toe and second toe off my right food were jambed together (unknown to me as it did not hurt). When I removed the shoes I noticed a swelling on the right lateral border of the nail bed near the base and it hurt when I pushed it – it was flesh colored no hematoma. It has not gotten better or worse since that time. It hurts when I scrounge my toes together and fold them down. It hurts when I am in bed when the covers push on it heavily but is ok otherwise – I can even run and ride and it doesn’t particularly hurt. However when it hurts it’s significant. I have attached photos from this morning so you can see the offender. It is red and swollen relative to the big toe on the left foot.
Now a little back story – about 3 months ago I think I broke a bit of the bone on this same toe by smashing it into a step in my house at very high speed. Hurt like heck for several weeks – but I took a (dental) xray of it and I determined it would be fine and so it was after a few weeks – that is what caused the purple line across the nail. I have attached that film as well in case it is pertinent. By the way I don’t want you to start self-diagnosing any gum problems you may develop!
So what is it and what do I do? Thanks, Steve (name changed)
Dr Blake's response:
Steve, First of all those are better toe xrays than I get from St Francis, so I am going to send all my patients who need xrays to you. Secondly, you have a proximal ingrown toenail that I need to dig out at some time. It is not infected, but there is alot of congestion just past the cuticle. Sorry!! You are probably very brave for tolerating the tremendous pain you must be in. Tell Deborah you get an extra treat!! Rich
Steve came in about 3 days later and I removed the offending nail border back to the cuticle. Green pus came pouring out so it had become infected. He is soaking it in warm water with a tablespoon of Epsom salts (table salt just fine) for 30 minutes or more twice a day until all of the redness is gone. He is keeping topical antibiotic and a bandaid on as long as there is an opening. The soaking should pull out the remainder of gunk from the toe. Golden Rule of Foot: When dealing with an infected ingrown toenail, soak as long as possible and twice daily until the redness and pain begins to resolve (normally 2-3 days).