Sunday, January 8, 2012

How to Fail, with your Ingrown Toenail


For this post, I’d like to talk about one of the greatest and eternally significant orthopedic problem that orthopedic surgeons see almost daily: the ingrown toenail :)


Here’s a gory story of my patient with an ingrown toenail:

I had a patient who, would you believe, had an ingrown toenail which lasted for more than a year? I saw her more than a year ago, advised her that we should take a portion of the nail out, but I never saw her again after that.  A few days ago, lo and behold, I saw the patient again, as if resurrecting from the dead. She told me she tried doing some “bathroom surgery” on her own, that’s why she did not come back. But because the nail kept re-growing, puncturing the wound again and again, the wound got infected and the entire toe became filled with foul-smelling yellowish pus. (eeyucccck!)

I wanted to scare her to death by saying that if the wound doesn’t get well, I might have to cut off her toe!  (Scare tactics don’t work anymore. Look at the recent firecracker injury victims).

So I asked her “Do you love your toe?

“Of course, Doc.”

“If that’s the case, we have to pull out half of your toenail.”

Her jaw dropped. The next thing I saw, she was sprawled down on the floor. It turned out she fainted from what I told her.

After she regained her bearings, she finally consented to the procedure. However, the anesthesia didn’t work because of the pus. She told me the pain was horrific, that she was ready to recant anything I told her to recant, including the time she told me I was not handsome. (Pardon me for my hallucinations).

To summarize what happened, I cut her nail into two, and got my new shining metal pliers to yank the cut half.  My nostrils were attacked by a terrible stench because pus oozed out, with a little bit of bloody fountain coming with it. I then cleaned the wound well, including the nailbed underneath the nail.

(Note: I skewed a little bit in my description of the procedure. The local anesthesia actually worked but because I just want to gross you out, I exaggerated a bit. :))

And now, I hope you know what happened next.

It worked. 

The wound slowly healed over the next few days. 

Take home message

Ingrown toenails are extremely common but rarely get better. You may try treating it yourself but I would advise that you see a professional like an orthopedic surgeon to evaluate and treat you properly.  This story of my ingrown toenail patient looks simple and harmless. But it’s the story of the entire human race: People get stuck with problems since the time of Magellan. But while these problems may last for a long time, it takes only a few days or weeks to heal, after you have finally decided to do the right thing.

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