ESCANABA — Life can be painful. Sometimes it’s the emotional kind, but the physical kind is experienced by most of us, at least eventually. Time takes its toll on the human body and the years too often bring illness or disease. This can frequently result in pain. The location of the undesirable sensation may carry with it great concern, the obvious example being pain coming from your chest. But a particularly common location doesn’t usually generate the same level of interest: the area of the toenail (aka nail unit).

Other than beautification, much of the focus directed at our toenails is because of pain, commonly the result of subtle trauma to the fold of skin in which the nail edge resides. Although few think of them this way, toenails are a hard, rigid, unyielding structure and can damage skin. Improper trimming of the nail can lead to an ingrown nail but there are hundreds of reasons, from tight shoes to a game of tennis, sweaty feet to a stubbed toe.

Many human beings experience this sensation, pain along the sides of the toenail. Understandable since there is a high density of nerve endings in the area. The character of the pain can vary person to person, sometimes described as sore, burning, or sharp. The degree of disability varies tremendously, with infection and drainage often developing. For some, it’s an annoyance and nothing more, perhaps a little bathroom surgery resolves their discomfort (although not recommended). Although this approach to treatment may be able to manage the discomfort, it is not a solution, usually providing only temporary respite.

When ingrown nails are recurrent, typically the root of the problem is, quite literally, the nail root. This is the structure which produces the nail plate, and if your nail root (technically referred to as the nail matrix) is excessively curved, so will be the nail that is produced. Consequently, you will always grow a toenail which, under the stresses of life (and shoes), is “stabbing” you in the toe. Not a particularly pleasant sensation to live with.

Because of the environment, packed inside a shoe, hidden away, the groove of skin in which the edge of nail resides is a fine breeding ground for bacteria. And when the edge of a nail irritates or pressures the skin sufficiently, the microbes hanging out have access to our interior, in other words there is bacterial invasion. This is one of the more significant complications of an ingrown nail condition.

When such an infection develops, oral antibiotics can be helpful in treating the infection, but the cause of the infection is the piercing appendage, the ingrowing nail plate. Removal of the offending border of nail, painlessly performed with local anesthetics, will reliably result in resolution of the infection and pain. And typically without the use of antibiotics. Exceptions to this generalization would be in the immunocompromised individual, such as someone with uncontrolled diabetes.

The removal of the edge of the nail in someone who has ingrown nail pain has been the treatment of choice for many decades. The technique, when properly performed, reliably achieves resolution of the acute problem. But for how long? When the edge of nail is removed but nothing else done, the nail root will continue to create the misshapen nail plate. Where the edge of nail was removed, a new edge will gradually regrow. Eventually, after months have passed, the regrown edge will be shaped as it previously was and will poke the individual in the toe once again. This is why these are so commonly a recurrent issue.

As the astute reader may be asking themselves, why not surgically change the shape of the root? This was attempted but with disastrous results. Pain and disfigurement was usually the result and the procedure was abandoned. Instead, eradication of the nail root in some fashion was found to be a viable concept. The next question was how best to achieve this goal of permanent removal of some portion of the nail root, obviously the one growing the ingrowing edge.

Over 80 years ago, the use of a powerful acid was applied to the nail root as a way to alter irrevocably the width of the nail plate. Indeed, it was a success and went on to become the optimal method of treating a recurrent ingrown nail condition. But technology has progressed and new options have become available. Although it remains remarkably popular, the acid technique has its downsides and detractors. This powerful acid burns tissue, which consequently heals slowly and requires prolonged soaking post-operatively to assist in healing the wound.

Some say a better option is the use of high intensity radio waves, the process being termed radiofrequency coblation. One of the advantages of this technology is the absence of burned tissue, such as occurs when an acid is applied. The upshot is faster healing (also resulting in reduced bandaging time). Even better, the rate of recurrence is much lower, meaning the edge treated regrows less often.

Other methods of removing the nail root are available. The ‘sharp’ technique is aptly named since a scalpel is used to literally cut away the desired nail root. The post-operative pain was usually significant and the toe often disfigured afterward. A laser has been used but too often the nail ‘permanently removed’ grew back, meaning the procedure failed.

Although there are few definitive studies on the condition, ingrown nails are obviously very common, as any podiatrist can tell you. Typically not limb threatening, they can reduce your quality of life and should be treated. Although removing just the edge of nail provides relief much of the time, addressing the ‘root’ of the problem is commonly beneficial. When there’s such an elegant solution, living with this condition becomes unnecessary. Your quality of life is important.

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Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with offices in Escanaba, Marquette, and L’Anse. McLean has lectured internationally on wound care and surgery, being board certified in surgery, orthotic therapy and wound care. His articles on health and wellness appear in multiple local and national publications. Dr. McLean welcomes subject requests for future articles at drcmclean@outlook.com.