Ingrown toenail surgery—is it right for you?

Ingrown toenail surgery—is it right for you?

Ingrown toenail surgery—is it right for you? - 1

Ingrown toenail surgery—is it right for you?

What does ingrown toenail surgery involve?

Surgery to address an ingrown toenail (onychocryptosis) involves removing the bothersome nail and applying a chemical to prevent the nail from growing back.

In some instances it may be necessary or most beneficial to remove a small section of nail at one or both sides, but on the odd occasion the entire nail (total nail avulsion) will be removed.

It is a quick and simple procedure than is essentially pain free as it is performed with an injection of local anaesthetic.

Following surgery the toe is dressed and generally speaking there is little, if any, pain or discomfort. You may expect some throbbing that night or discomfort but this is most often managed well with paracetamol.

When is toenail surgery the best option?

Ingrown toenail surgery should not be considered first-line treatment for an ingrown toenail. It can be considered when:

  • Other non-surgical methods have been exhausted
  • The nail is involuted or curved
  • Ingrown toenail is problematic, painful or recurring
  • You understand the implications and potential complication of surgery
  • You have discussed any concerns with your podiatrist

What are the advantages of clinic-based toenail surgery?

  • No time in hospital
  • No Sutures / stitches required – all completed under the nail plate
  • No more recurrent ingrown toenails
  • Pain free
  • Minimal time off work
  • Reduced episodes of infection and lesions (weeping, bleeding)
  • In the majority of cases, ingrown toenail surgery is very successful

Dr Brenden Brown, podiatrist and founder of A Step Ahead Foot + Ankle Care, says, “Nail surgeries are not new for podiatrists; we perform them on a regular basis. It is part of our training at University so we are well versed in this surgery. It is carried out in our clinic and, due to our high level of training, is a fairly simple procedure.

“I often describe this surgery as ‘relatively pain free’. It is wrong to say any surgical procedure is ‘completely pain free’ but as procedures go our patients report very little, if any, pain.  In fact, patients are frequently surprised at just how pain free it actually is!

“This procedure can certainly be of benefit and is recommended for patients who have a history of infection or recurrent ingrown toenails. It’s also very helpful for patients with involuted or very curved nails and toenails with areas that seem to catch the skin on the side of the nail.

“Patients often suffer from an ingrown toenail for many years with little idea where to go to for help.

“The days of painful surgeries with patients regularly experience nail re-growth are gone. It’s also important to remember that what you see on YouTube and other social media sites is often the ‘most horrible’ and ‘most atrocious’. If it wasn’t so gruesome you probably wouldn’t have been so motivated to watch and it likely would have got the “views” it did!

Related articles:

5 hacks to keep ingrown toenails at bay

ABOUT US

A Step Ahead Foot + Ankle Care is one of Sydney’s leading foot and ankle clinics. Principal podiatrist and founder of A Step Ahead Dr Brenden Brown (AKA Dr Foot) has been taking care of people’s feet for more than 20 years.

With a background in sports medicine and having served as a former president of the Australasian Podiatry Council, Brenden is a wealth of information when it comes to foot and ankle care.

Got a question? Check out our Instagram profile #AskDrFoot

Tune into our Facebook page for regular live videos and updates on the latest foot and ankle advice from the experts.

5 hacks to keep ingrown toenails at bay

5 hacks to keep ingrown toenails at bay

5 hacks to keep ingrown toenails at bay - 1

5 hacks to keep ingrown toenails at bay

What causes an ingrown toenail?

Ingrown toenail (known medically as onychocryptosis) is a condition where the edge of the toenail (most commonly on the big toe) pierces or catches on the skin as it grows up.

MYTH: Nails only grow upwards they do not on any occasion grow outwards towards the side.

There are several causes of an ingrown toenail but probably the most widespread is poor toenail-trimming technique. Cutting down the side of the nail is a major no-no. Why? Because even the smallest spike of nail can grow up and penetrate, or get caught on, the skin.

The ingrown slither of nail acts like a splinter; the skin around it thinks it’s a foreign body and becomes inflamed and infected.

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5 hacks to prevent ingrown toenails

  1. Clip with caution. Trim toenails straight across. DO NOT cut down the sides of the nail and refrain from cutting nails too short
  2. Refrain from ripping the nails down the sides. We have all done this! You cut but you can’t get that last bit of nail, so you abandon the clippers and rip the last piece down the side. This leaves a sharp spike, which may not be painful now but in following days it will grow upwards and catch on the skin piercing it creating the subsequent infection and PAIN!
  3. Ditch footwear that is too tight or constricts the toes from moving. This can push the nail into the skin causing irritation and infection
  4. Steer clear of unqualified people offering to remove ingrown toenails. While this may sound somewhat self-serving, there are an increasing number of nail salons offering to perform this sort of work. Removing the nail breaks the skin barrier, which can easily become infected. Whilst your podiatrist makes it look easy that is because it’s what they have been trained to do and complete on a regular basis.
  5. Adhere to best-practice foot care by keeping feet clean and dry to avoid weak, splitting nail and fungal infections.

How to fix ingrown toenails — at home

To treat an ingrown toenail at home you can try: Cutting the nails straight across and applying an antibiotic cream to help reduce the risk of infection and subsequent inflammation. You can also use a nail file to round the corners!

MYTH: Cutting a V in your toenail will not make it grow inwards; nails only grow upwards. While the V may look like it’s closing in, this is an illusion as you are trimming the top of the V, making it appear like the V is getting smaller over time.

Applying a small piece of cotton wool between the ingrown nail and the skin can help life the nail, hopefully clearing it and preventing the nail from piercing the skin again.

Avoid wearing high heels, pointed or tight fitting shoes as these can place pressure on the affected area, potentially delaying healing.

The professional approach

Dr Brenden Brown, podiatrist and founder of A Step Ahead Foot + Ankle Care, says, “If the toenail turns into a monster and becomes red, angry or infected—It’s definitely time to seek professional advice.

“A podiatrist can easily treat an ingrown toenail by removing the troublesome spike of nail. In most cases this is a quick (takes minutes) and simple procedure, which is completely painless.

“Following the removal of the nail spile, the toenail area is cleaned and, if infection has been present, the toe will be dressed.

“In extreme cases, toenail surgery may be required. This will generally only happen if the patient has a repeated history of recurrent in grown nails or if the nails shape means it requires removal of that section, such as when it is involuted or excessively curved.

“It is more rare than most people think to remove a whole nail as we can manage these well conservatively”

Related articles:

Ingrown toenail surgery—is it right for you?

ABOUT US

A Step Ahead Foot + Ankle Care is one of Sydney’s leading foot and ankle clinics. Principal podiatrist and founder of A Step Ahead Dr Brenden Brown (AKA Dr Foot) has been taking care of people’s feet for more than 20 years.

With a background in sports medicine and having served as a former president of the Australasian Podiatry Council, Brenden is a wealth of information when it comes to foot and ankle care.

Got a question? Check out our Instagram profile #AskDrFoot

Tune into our Facebook page for regular live videos and updates on the latest foot and ankle advice from the experts.

What’s causing your child’s heel pain?

What’s causing your child’s heel pain?

What’s causing your child’s heel pain? - 1

What’s causing your child’s heel pain?

Heel pain in kids is incredibly common. In fact, kids’ sports teams can have up to 30 or 40% of children experiencing heel pain at any one time.

“The greatest incidence of heel pain in children is generally seen in those aged 8-16, who have increased their physical activity in volume, intensity or frequency,” says sports podiatrist and founder of A Step Ahead Foot + Ankle Care Dr Brenden Brown.

Causes of heel pain

There’s a myriad causes of heel pain from soft tissue infection and Sever’s disease to juvenile rheumatoid arthritis, plantar fasciitis and tibialis posterior tendonopathy (muscle overuse).

The question is, what’s causing your kid’s heel pain?

Two of the most common causes of heel pain are Sever’s disease and tibialis posterior tendonopathy,” says Dr Brenden.

“However, many coaches and healthcare practitioners mistakenly over-diagnose childhood heel pain for Sever’s disease—when the underlying cause is tibialis posterior tendonopathy.

Sever’s disease and tibialis posterior tendonopathy often share common areas of pain and overlapping symptoms. Yet, unless properly diagnosed treatment will be incorrect and may lead to ongoing pain.

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Sever’s disease

“Although more of a repetitive strain injury than an actual disease—Sever’s disease (known medically as a self-limiting calcaneal apophysitis!) is a result of irritation, stress and inflammation of the growth plate (centre) of the heel bone,” explains Dr Brenden.

Causes of Sever’s disease can include:

  • Rapidly or recently increasing physical activity in volume, intensity or frequency
  • Doing sports in bare feet
  • Excessive walking in thongs
  • Poor foot posture (flat feet)
  • Weak foot muscles

Symptoms of Sever’s disease include:

  • Pain and stiffness in the heel
  • Heel pain after sport
  • Swelling on the heel, which may be sore to touch
  • Limping
  • Tiptoeing to avoid heel contact with the floor

Tibialis posterior tendonopathy

“Tibialis posterior tendonopathy is a common overuse injury, which may occur due to sudden increases and changes in sports training. It’s a result of the muscles overworking in an attempt to roll the foot and ankle outwards.

“People with over-pronation (often recognised as a flattening or rolling in of the foot) can experience the symptoms of tibialis posterior tendonopathy as a result of the muscles overworking to correct poor foot posture,” says Dr Brenden.

Causes of tibialis posterior tendonopathy can include:

  • Poor foot posture (Flat feet is the most common cause)
  • Rapid or recent increases in volume, intensity or frequency of physical activity
  • Completing sport in bare feet
  • Walking excessively in thongs
  • Poor footwear choices
  • Weak foot muscles

Tibialis posterior tendonopathy symptoms include:

  • Pain and stiffness located around inside of ankle
  • Heel pain after sport
  • Swelling of inside of ankle
  • Pain during and after sport
  • Pain sometimes confused with “growing pains”

Sever’s vs tibialis posterior tendonopathy (TPT)

While the causes of Sever’s disease and tibialis posterior tendonopathy are similar, there are some key differences to differentiate them.

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THE GOOD NEWS: both Sever’s disease and tibialis posterior tendonopathy pain have successful treatment protocols.

If your child is suffering from heel pain it’s important to have their feet professionally checked to identify the ‘actual’ cause of their heel pain and start them off on the correct treatment path.

Treatments include deep massage, strengthening protocols, stretching, footwear recommendations and orthoses should foot posture issues be present.

 Related articles:

Think you have a heel spur? Think again

10 things you should know about heel pain

In the media: Dr Brenden Brown talking heel pain

Want to know more about taking care of kids’ feet? Visit: mykidsfootdoctor.com.au.

A Step Ahead Foot + Ankle Care is one of Sydney’s leading foot and ankle clinics. Principal podiatrist and founder of A Step Ahead Dr Brenden Brown (AKA Dr Foot) has been taking care of people’s feet for more than 20 years.

With a background in sports medicine and having served as a former president of the Australasian Podiatry Council, Brenden is a wealth of information when it comes to foot and ankle care.

Warming up for sports—why bother?

Warming up for sports—why bother?

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Warming up for sports—why bother?

“Warm-ups have the ability to help prepare the muscles for activity. However, what’s changed is that we now question many ‘traditional’ warm-up methods; evidence suggests that static stretching probably shouldn’t be part of most people’s warm up routine,” says founder of A Step Ahead Foot + Ankle Care Dr Brenden Brown.

“The days of a few quick hamstring stretches followed by a run around the field are long gone. Modern warm-ups are more cleverly designed; they need to be more specific to the sport we’re playing or the activity we’re embarking on.”

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The benefits of warm-ups

Preparing the body for participation in sports by warming up, will enhance the maximal performance and reduce the risk of injury! This is a sentence I often find myself repeating over and over again to my young patients,” says Dr Brenden.

“The Netball World Cup was a great example of how warming up is directly linked to injury prevention and optimum performance. The public was able to see first hand the amount of time the best teams in the world spend on warming up before games.

Warming up improves blood flow to the heart, increases the muscle temperature and makes muscles more pliable.

“Cold or less pliable or elastic muscle works harder to accommodate a given load and will be more resistant to sudden stretch.  Less pliable muscle tissue is also more susceptible to overuse injuries.

“No matter what the sport or activity is, players can begin their warm-up by walking a couple of laps of the soccer field or court. Increase the pace on the second lap to turn it in to a brisk walk but don’t jog or run.

“As you walk you’re infusing the tissue and muscles with blood to gently warm up the body. At the end of a gentle warm-up your muscles are ready to be used.”

The ‘right’ kind of netball warm-up

“I continue to see kids doing two types of warm-ups. They either run from one end of the netball court to the other and that’s it or they go back to the classic—are dare I say outdated—routine involving calf stretches, hamstring stretches, touching toes and throwing the ball into the hoop.

“If we take netball as an example, the warm-ups need to be specific to the sport. Most netballers need to be doing lots of side-to-side movements, twists, turning and cutting movements.

“This might include doing the grapevine across the court, side-to-side stepping, moving up to side-to-side hoping and jumping. Standing still, pointing the toe and rotating the ankle is also useful as part of a warm-up.

“The warm-up routine needn’t take half an hour but it should take approximately 10-15 minutes.”

Warming up for sports—why bother? - 3

To stretch or not to stretch—this is the question!

Dr Brenden explains, “By stretching out a muscle and holding it there (static stretching) we’re pushing the tissue past where it needs to go, which could do more harm than good.

“This type of stretching is also not sports specific. However, stretching doesn’t always mean stretching out a muscle and holding it there.

Dynamic stretches differ from the norm in that they stretch the body through movement. So instead of holding the muscle in a static stretched-out position, you move gradually through the movement.

“At best, I’d call this a light stretch. There should be no risk of over-stretching the muscles.”

8 reasons to warm up

  • Increases range of movement
  • Warms up muscles in prepares for activity
  • Increases fluid production to lubricate joints
  • Triggers the neural pathways between your brain and your muscles
  • Improves reaction and response time
  • Reduces risk of injury
  • Potential to improve performance
  • Helps improve recovery time
Related articles:

Winter sports’ greatest enemy….ankle sprain

Your guide to rock-solid ankle stability

A Step Ahead Foot + Ankle Care is one of Sydney’s leading foot and ankle clinics. Principal podiatrist and founder of A Step Ahead Dr Brenden Brown (AKA Dr Foot) has been taking care of people’s feet for more than 20 years.

With a background in sports medicine and having served as a former president of the Australasian Podiatry Council, Brenden is a wealth of information when it comes to foot and ankle care.

Winter sports’ greatest enemy…ankle sprain

Winter sports’ greatest enemy…ankle sprain

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Winter sports’ greatest enemy…ankle sprain

Winter sports season means netball, footy and rugby union games galore (maybe even a spot of skiing!), but it also presents the increased risk of ankle sprains and strains…

“The chilly season means that muscles become cold. Without adequate warm-up exercises the muscles and connective tissue aren’t as flexible as they should be and this can lead to injury,” says Dr Brenden Brown, sports podiatrist and founder of A Step Ahead Foot + Ankle Care.

Dr Brenden is calling on health practitioners to “up their ankle game” beyond the simple “text book approach”.

Ankle sprains are a common winter sports injury. They occur as a result of involuntary sliding or twisting of the feet when you step on slippery or unstable ground. The sprain happens when the foot is forced into an unnatural position

“The intensity at which the ligaments stretch can sometimes be so severe that it causes fracture or serious inflammation and pains. Doing whatever you can to prevent an ankle sprain is a no-brainer.”

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Avoiding winter sports ankle injuries

Planning ahead is a great way to prevent winter sports injuries—particularly when it comes to ankle injuries. With the right preparation and precautions you can reduce the risk of an ankle sprain or strain.

“The common preventative treatment for ankle sprains is balance exercises, but while this might go some way to help reduce ankle sprains the approach really needs to be multi-factorial,” says Dr Brenden.

“To lessen the risk of injury you need to use taping, bracing and practice strength exercises.”

But be warned, Dr Brenden explains that many healthcare professionals—including, physios, chiros, sports coaches and others—at times only suggest doing calf raises. He says, “This is fine if the sport you’re doing only requires you to move the ankle up and down, but if your sport means moving your ankles side to side (for example, skiing, netball, rugby league, football and almost all sports!) then calf raises are of no use.

A textbook response to ankle sprains will often end patients in trouble. If your health professional is merely suggesting calf raises, it’s time to look further afield.

“More and more evidence suggests we need to look much further up the body, toward the gluteal muscles and alike.

“As such, your strength training needs to incorporate more than just your ankle and should be more sport specific.”

Dr Brenden says you need to functionally challenge the ankle in order to strengthen it appropriately and a special emphasis should be on preparation.

“Those participating in winter sports (or any sports for that matter!) can benefit from completing a tailored muscle strength-conditioning program. This is particularly the case if you’ve suffered a previous ankle sprain or are at high risk of injury.”

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Points to note:

  • Ankle strengthening activities should include hoping, jumping and cutting movements if that is part of your sport
  • Strength exercises should include loading the muscles to be able to dynamically work as they would in your chosen sport
  • Loading the muscle prepares your muscles for the activity ahead. This may include using more than just weight-bearing exercises and incorporating resistance-based training.

Additional measures to help prevent ankle sprains include:

  • Warming up. Cold muscles are less flexible and more prone to injury
  • Wearing footwear appropriate to your sport
  • Making sure your footwear fits you properly (loose boots can cause falls, increasing risk of ankle injury)
  • Taking the time to cool down. Slow stretching can reduce post-sports muscle tightness and soreness and may help reduce future risk of injury
  • Knowing your limits and sticking to them

Treating your ankle sprain

The immediate treatment for an ankle sprain is the RICE approach. This incorporates: Rest, Ice, Compression and Elevation.

  • REST: “if it hurts don’t do it”. Giving your ankle a period of rest after the sprain can assist with healing
  • ICE: apply ice packs to the ankles, or area of discomfort
  • COMPRESSION: apply bandages over the injured area. Compression socks are available from your local podiatrist’s clinic
  • ELEVATION: lift the foot up above the waist or heart.

“Evidence shows that ankle sprains are unlikely to get better by themselves. Plus once you have an ankle sprain, you’re significantly more likely to have another sprain.”

“So just like the pre-sport preparation phase, it’s time to get back to strength and exercise-based rehabilitation as your next phase in rehab,” says Dr Brenden.

Related articles:

Your guide to rock-solid ankle stability

Your guide to choosing the best netball shoe

Your guide to choosing a footy boot

Think you have a heel spur, think again

A Step Ahead Foot + Ankle Care is one of Sydney’s leading foot and ankle clinics. Principal podiatrist and founder of A Step Ahead Dr Brenden Brown (AKA Dr Foot) has been taking care of people’s feet for more than 20 years.

With a background in sports medicine and having served as a former president of the Australasian Podiatry Council, Brenden is a wealth of information when it comes to foot and ankle care.