An ingrown toenail stems from irregular nail plate growth from the nail matrix. This condition can be very painful. There will be redness and swelling around the ingrown nail. If the ingrown toenail is not treated, an infection can occur. Tight fitting shoes or micro trauma to the nail can cause an ingrown toenail to occur. We encourage patients to avoid bathroom surgery, as this only leads to recurrence of the ingrown nail and possible infection.
If you suspect an ingrown toenail, avoid tight fitting shoes. Monitor for signs of infection: redness, swelling, warmth, pus, etc. Avoid trying to remove the nail yourself (aka bathroom surgery). Most home treatment regimes for ingrown nails don’t address the nail matrix. As a result, patients who self treat their ingrown nails tend to develop recurrence.
We offer partial and complete nail removal options. We use a local anesthetic to numb the toe prior to the procedure (this is the most painful part of the procedure). The ingrown nail removal procedure itself is painless and takes about 10 minutes.
During your initial consult, you will have the option to have your ingrown nail permanently removed. Permanent removal of the nail involves the application of a chemical, sodium hydroxide, to the nail matrix. This chemical prevents this area of the nail from becoming ingrown again. You will also be given the option to have the nail, or nail border removed without sodium hydroxide application. Although, this can serve as a good option in some cases, the likelihood of the nail become ingrown again is high. All ingrown nail treatment options will be discussed with you at the time of your consult.
Athlete’s foot, also termed tinea pedis, is a common fungal foot condition. The condition can present in the web spaces of the toes, or involve the entire sole of the foot. A small area of infection can actually spread to the rest of the foot. This happens after the foot has been in shoes and socks for hours each day. Symptoms include redness, flaky skin, and itching to the infected areas.
If you suspect that you have athlete’s foot, make sure that you wash and dry your feet well every day. If you tend to have sweaty feet, make sure you change your socks throughout the day. Also, try to spend most of your day without shoes if possible. An over the counter topical antifungal such as Clotrimazole or Lamisil may treat your symptoms. However, if the infection does not resolve, or worsens, it is best to seek medical care.
Corns & Callouses
Corns and callouses develop from pressure and friction in specific areas during weight bearing. The skin responds by increasing keratin production in these areas. The skin will then feel tougher and thicker in these areas. Boney prominences are the areas that are most likely involved. Corns and callouses can be painful if they are left untreated.
The use of an over the counter pumice stones can be a daily routine to remove corns or callouses. This practice is best performed after a bath or shower when the skin is softer. Vaseline can help to soften callouses. However, it is not as effective as a prescription keratolytic cream. If your corns or callouses are not responding to home treatment, or if they are getting increasingly more painful, it is best to seek medical attention.
Your corn or callous will be evaluated at your initial consult. Corns and callous can be shaved down or removed in clinic using a surgical blade. This is a quick and painless procedure. Prescription keratolytic creams are prescribed, such as Urea 20%. Patients are instructed to apply these creams twice daily. Accommodative orthotics are recommended to offload areas of high pressure and friction to prevent recurrence of these lesions. Cantharone is a topical agent can be applied to recurrent corns. This will be offered during your initial consult. Painful, recurrent corns may have to be surgically removed.
There are over-the-counter topical treatment options that you can try, but these tend to have limited success. Fungus can be picked up anywhere, and is very difficult to get rid off. Throwing away your shoes, or trying to disinfect your entire home has limited success in getting rid of the fungus.
Treatment must be targeted at the nail bed rather than just the nail plate. A thick, discolored nail can also be caused by nail bed trauma. A nail biopsy is the gold standard to diagnose onycomycosis. This is a quick and painless procedure preformed in clinic, that involves taking a small clipping of your nail and sending it off to pathology. If the nail biopsy confirms onycomycosis, then oral and topical treatment options can be discussed. Oral anti-fungal medications do have a black box warning regarding liver toxicity. Although rare, we take this into account prior to prescribing oral medications. Liver function tests will be performed prior to starting any oral anti-fungal medication. Patients are also given the option to remove the infected nail permanently.
There are over-the-counter treatment options for treating plantar warts (i.e Compound W). Plantar warts may resolve within several months without any medical treatment. However, most cases of plantar warts don’t resolve on their own, and may even spread to other parts of the foot.
Although there are various treatment options for plantar warts, cantharone application is our preferred method. Most patients have resolution of their wart two weeks after cantharone application. Surgical removal of warts is the last line of therapy.