Ingrown toenails and plantar warts are two of the most common dermatological foot pathologies presenting to podiatrists today. This article will review the basic pathologies as well as the possible treatments for these disease processes.
An ingrown toenail is common, when a side or corner of a toenail grows into the flesh of the toe. Inflammation, redness, pain, swelling, and soft tissue infections and cellulitis and paronychia may be presenting signs of this condition. Ingrown toenails can result from several different processes: from trauma to the nail causing it to splinter and pierce into the skin around the nail to thickened fungal toenails that are brittle and splinter; or also from improper cutting of the toenails to microtrauma of tight shoes or improper footwear.
Ingrown toenails can be treated in different ways; but the most common treatment requires local anesthetic block of the affected toe and then splitting the side of the nail straight back from the tip to the base of the nail and avulsing the offending piece of toenail. If the entire toenail is involved, then a total avulsion might be performed. A chemical matrixectomy is usually performed at this point using phenol, especially if the condition is chronic. The toenail is dressed with a topical antibiotic ointment, non stick pad, gauze, and mild compression. Patients are given post operative care instructions including soaking the toe in lukewarm soapy water and using topical wound care from two to four weeks. Commonly the toe will drain and ooze clear to serosanguinous fluid which tends to resolve as the healing process continues. Secondary soft tissue infections may occur; but most of the time by relieving the offending nail the pain and potential infection resolve.
Plantar warts, verrucae plantaris, is a skin condition caused by the human papilloma virus, in which the virus invades the skin and produces hyperkeratotic tissue; and based on the area of the foot in which the wart infects the skin, it can be quite uncomfortable and painful due to pressure. The pressure from the ground forces can make the wart tissue appear to grow “inverted” into the plantar skin, causing more pain for patients.
Treatment options for Wart destruction range from benign neglect (spontaneous regression in two years may occur) to blistering the wart tissue with acid vessication, or anesthetizing the area and performing currettage and cauterization. Bleomycin is sometimes injected as well for destruction of the warts also. The procedure I use in my practice is the use of canthardine as a vessicant placed on the wart under 48-72 hours of dry occlusion in which time a blister forms separating the outer wart infected epidermis from the dermal junction. In two weeks, I deroof any remaining blister and dress the area with antibiotic ointment and bandages. Occasionally a second application may be necessary; or advance to currettage and cautery.
Treating these common conditions is rewarding. Most of the patients that present to the office with these condition and are able to have a simple office procedure on the same day and healing is fast with few risks and low infection rates. It is a pleasure providing basic podiatric care to patients, educating them on their conditions and helping them understand how to manage their problem and make educated decisions. If there are certain areas of podiatric medicine which you would like to have more information on, please feel free to contact me. It is important to collaborate with fellow physicians in the management of the patients in our community.
About the Author
Chris Nelson Bryant, D.P.M.
Kentucky Foot Professionals