A patient came into the office with pain in her left great toe. She was 35 years old and smoked two or three cigarettes a day and took no medicines. The pain in her toe was constant for two months or so and recently it had become red and swollen. Her pulses in her left foot were poor and X-rays showed bone destruction in the same area as the redness and pain. She had a nail infection which, when combined with poor circulation, had created not only a nail problem but a bone infection. To start with, she needed a vascular procedure to restore blood flow to her left foot involving a new tube to bring blood from her thigh down to the top of her foot. Next, she required a partial toe amputation to remove the infected bone. She healed perfectly well and walks without a limp, but she is a good example of a toenail nightmare.

A toenail is something you can live without. However, similar to your appendix or spleen, it can become a living nightmare when it becomes troublesome. Toenails become thicker and more curved as we age, and when this is combined with poor eyesight, stiff backs, big bellies or arthritic hands, it becomes challenging to do something we have done well for many years. A person can clip their toenails flawlessly for 30 years straight and then one day they clip too much off of one edge of one toenail. The swelling and redness begins several days later and then unbearable tenderness appears whenever the shoes rub in this inflamed area. The tenderness will ebb and flow depending on what the foot is asked to do. Swelling of the soft tissues covers the irritating nail with granulation tissue (a healthy, red, beefy bloody tissue). This is your body's attempt to dissolve the offending nail edge. If you play with this beefy tissue, you will find out how gory this tissue can be. This ingrown nail pushing into the surrounding skin will create a full-blown infection given the right circumstances. Bacteria normally occurring on the skin surface are the most common sources for toenail infections. Once the nail is far enough into the tissues, then only removal of part or the entire nail will be sufficient to give complete healing. Small spikes of toenail are often the culprit when you attempt to trim a toenail without actually seeing what you are trimming. Oral antibiotics play a critical role by removing the skin and soft tissue structure infection, but similar to abscess treatment, the pivotal part is often the lancing of the boil, blister or abscess and removal of the foreign material.

My advice is really simple on this entire topic. Don't try fixing toenail problems in your bathroom. It hurts a lot and there is no need for the pain and suffering.

If your toenail is headed in the wrong direction, get it looked at by a professional as soon as possible. You will not regret your decision.

Dr. Daniel Smith is a podiatrist who practices at 27 Fennell St. in Skaneateles. He is board-certified by the American Board of Podiatric Surgery and the American Board of Podiatric Orthopedics and Primary Podiatric Medicine. He can be reached at 685-3338 or through www.westsidepodiatrycenter.com