6 Common Fungal and Ingrown Toenail FAQs
June 15, 2021 by Dr. Moore
Let’s talk about ingrown toenails and the biggest fear my patients have – not that it’s going to hurt that much, although that is one of their fears – it’s how ugly it’s going to look or how much of the toenail edge you’re going to remove.
So in short, once the area is anesthetized, back here behind the toenail, the entire toe becomes numb. You will not feel anything. And that’s the nice part about anesthesia is that it’s not partial or it’s not injected right into the toenail like some of the emergency room personnel will do. This is a complete toe numbing that is performed in the office by myself or one of my nurses. And again, you will not feel any pain.
What’s Involved In an Ingrown Toenail Removal Procedure?
Then as for the procedure itself. Over the years, we’ve developed a technique where the procedure itself is just at the edge, right where the skin meets the toenail. So it’s not necessary anymore to take a large piece of toenail, but just the piece that disappears down into the nail fold where it’s really digging in. And once that piece is pulled out under anesthesia it’s basically like removing a tooth, if you will, at the dentist; it’s out.
And then I push the skin up against the new edge to make sure that it looks cosmetically acceptable. And the root where the old ingrown portion was, is then killed utilizing a chemical and a special technique with a tool we use.
And in short, what happens is just the ingrown area below the nail fold or down in the groove that was causing the pain is gone. And it does not come back. That to me is big to pass on to patients because they have been told different things and not to mention the ones that come back to me with one, two or even three removals from different practitioners or their family practitioner who gives them temporary relief, and of course it’s a great procedure but they really wanted it gone permanently.
All that said, after the procedure, it will drain slightly since it is a mild chemical burn, but, for certain patients, we might place them on antibiotics if they had a bad infection. Other patients are very concerned with how bad the infection is and overgrowth of the soft portion of the nail over here in the skin area. But we can fix that too, at the time of the nail procedure.
Overall, it’s painless once the anesthesia is placed at the base of the toe. Cosmetically, we can remove all the infected tissue if it’s been a long-standing ingrown. And then third, of course, we can remove just the edge and make sure it’s cosmetically appealing when it does heal. And then the roots are killed. And again, most importantly, it does not come back.
What Are Fungal Toenails?
Fungal toenails is a bittersweet discussion with some of my patients, especially my female patients. I asked my girls (I have twin daughters) – “What’s the most important thing on your list?” And they said, “Clothing and I think shoes and then of course, pedicures,” – it’s just funny how important a good-looking toenail is to some patients.
I find the truth works the best. And here goes – pressure is really the culprit behind some of the thick, dark toenails. So I tell my patients there’s some good news and bad news about fungal toenails. And we get into that doctor neighbor portion of my practice, where some neighbor has told them, “Oh my God, it’s, you can spread it to everybody it’s a terrible fungal disease.” And I like to not only tell them the truth upfront but I like to tell them that some of these things are just pure myths.
What Causes a Fungal Toenail?
So let’s start off on what causes a fungal toenail and 9 times out of 10, it’s the pressure against the shoe and a little bit of genetics. So for example, a grandma and grandpa have thick discolored nails. There’s a chance it’s going to be passed down to you.
Second of all, my runners are folks with tight shoes. The constant beating on a toenail will make it thicker because toenails are the same protein as calluses. And if you have pressure on a certain area it’ll make a thick callus. You have pressure on a toenail, and it will respond and get thicker and darker. So some of my patients that have more pigment in their skin or darker colored in their skin coloring, will produce stripes and also little veins, if you will, of darkness in the toenail.
And that has nothing to do with some sort of dreaded fungus infection. It’s just from beating a toenail up. Second of all, the toenail can actually lift up or become so thick the layers are spread out and then the fungus gets in. So once that happens, I think the best thing to do is test, instead of throwing a blanket treatment at the patient and saying, “Hey, here’s some topical,” which usually the paint on ones or gels don’t work.
But very, very intense upon talking to them about shoe gear and not having the toenails beat up or exercise regimes. Once they get to that level, I’m a firm believer in the oral antifungals if the fungal toenail comes up positive on the testing.
What Are Antifungal Medications?
And let’s talk about that next – antifungal medications and different types of oral medications have come a long way. The one we use is, does make the liver work a bit harder but to put you at ease. So does alcohol, so does Tylenol and a lot of these drugs that make the liver work harder just means it detoxifies the drug.
So long story short, we do a full examination, check your medications, our electronic computer system will see if there’s any interactions. And then if there’s any questions about a heart patient or someone with really questionable liver problems, we’ll contact their primary care internal medicine doctor, or of course, cardiologists just to make sure there aren’t any cholesterol drugs that interact with this drug. Once we feel comfortable about it, I’ll tell the patient. “This is not a dangerous drug.”
In fact, the new standards for this drug is not having to test beforehand anymore but I will still test probably two to three weeks into giving the drug, just to make sure that, you know, that one in a million chance or someone has an actual reaction to the drug. We can test liver enzymes. And then of course, cease a drug. So long story short, it’s a drug you take for three months. It makes the liver work a little harder and (knock on wood) I’ve never had any problems in my clinic with liver problems associated with this drug and the patients do well.
The drug gets right into the root and it’s in the toenail. So the good news is it will continue to push the fungus forward, but some patients think that it circulates around and comes up underneath and just clears the whole toenail out. It’s a natural growing process. So the next thing you need to know is that it may take six, nine months in a row to get the whole toenail to grow out – a long process, but worth it.
What Results Should I Expect After Fungal Toenail Treatment?
I’ve had a lot of patients that have had great success. I just tell them to keep your eye on the prize and measure out what two or three millimeters is. And that is what it takes a toenail to grow from the root forward in two to three months. On average, a toenail grows a millimeter a month and then you can see the progression and of course, just be patient. And 9 times out of 10, it will clear up the toenail and hopefully flatten out the thickness which from time to time can vary from pressure.
Again, kind of a partnership between the patient’s actions and the shoe gear. And of course the drug we provide at the office.
Why Choose Dr. Moore?
Another important question that patients ask at our offices is that, why? Why should they use me or our surgeons to have this procedure or procedures performed? And it’s a very fair question, but personally, it’s hard to say how good I am and why am I the best at these types of procedures.
But to be honest, it’s a serious question and they need to know that this is all I’ve done. I mean, 25 years of this, not starting in one specialty and sliding into this later, foot and ankle surgery is all I’ve done for 25 years. And I’ve performed thousands of the types of procedures you’ll see on my website.
Another important point is the board certification, board certified with the national credentials that you would like your surgeon to have. And we keep it fresh in our practice where the students are constantly revolving through. And I’ve been a surgical instructor now for over 15 years at two residency programs here in Houston.
Lastly, understanding the equipment is important. So I actually invented a bone screw back in 2000 and went ahead to patent it with a surgical equipment company. And it’s still in use today to be able to make one of the surgeries we perform go a little bit smoother and faster. We covered pain and other types of outcome concerns that my patients have.
But another high concern they have is about financing. And also what’s going to happen after surgery. So I’d like to talk a little bit about patient concerns on that level. Over the years, the nice thing about practicing for this long is we have a staff that takes care of everything. And of course, I oversimplify it when I’m with a patient ’cause it’s not simple, but we have, when they come into the office, their insurance has already been verified.
We check to see where their deductible is, what type of out-of-pocket expenses they have just for the office visit. So at least you know where you are on that level and not all offices perform that service. Second of all, we look into the type of facility. For example, we have in-network and out of network facilities. I am an in-network surgeon provider, so they don’t have to worry about my coverage on their insurance.
And then of course, our office submits what types of procedures, checking if they are gonna be approved or not. So you’re guaranteed that they’re covered. And if you have interest or time to review these types of videos, we have our surgeries and our patient testimonials on our YouTube channel, which is MFAS clinic or short for Moore Foot and Ankle Specialists. Or you can go to our website at mfaspecialists.com – both of which have these videos available if you’d like to see the actual procedures or what patients have to say about them.