Ingrown Toenail (Permanent/Non Permanent)

Did you know there is a permanent solution to ingrown toenails so that you never have to deal with them again? Call 626-517-0022 to discuss further.

What is an ingrown toenail?

An ingrown toenail is a toenail that has grown into the skin instead of over it. This usually happens to the big toe, but it can also happen to other toes. An ingrown toenail can get infected. It may be painful, red, and swollen, and it may sometimes drain pus. (See a picture of an ingrown toenail)

Anyone can get an ingrown toenail, but adults get them more than children do. People who have curved or thick nails are more likely to get an ingrown toenail. This is more common in older adults.

What causes an ingrown toenail?

An ingrown toenail can have a number of different causes. Cutting your toenail too short or rounding the edge of the nail can cause it to grow into the skin. Wearing shoes or socks that don't fit well can also cause an ingrown toenail. If your shoes are too tight, such as a dress type shoe that is narrow at the front, might press the nail into the toe and cause it to grow into the skin.

You can get an ingrown toenail if you hurt your toe, such as stubbing it. This can cause the nail to grow inward. Repeating an activity that injuries the nail, such as kicking a soccer ball, can also cause an ingrown nail.

What are the symptoms?

The main symptom of an ingrown toenail is the pain from the nail growing into the skin instead of over it. If the ingrown toenail gets infected, it might be swollen or red, and it might drain pus. The area around the ingrown toenail is often painful.

How is an ingrown toenail diagnosed?

Dr. Shirazi will do a physical exam to diagnose an ingrown toenail. She will examine your toe where the nail has grown into the skin.

How is it treated?

Make an appointment ASAP as treatment is often more simple before the irritation or infection worsens. You may reach our office at 626-517-0022. In some cases, you may need antibiotics. Call Dr. Shirazi if your toe is red, warm, swollen, or drains pus, or if there are red streaks leading from your toe.

Do not use a sharp object like manicure scissors to dig under your nail, because this will worsen infection.

Wear comfortable shoes with a wide toe box, or sandals, that do not press on your toe.

If your toenail is very ingrown, your doctor might suggest a minor in office procedure to remove all or part of the ingrown nail.

During this procedure, Dr. Shirazi will numb your toe. Then she will cut the edge of the ingrown toenail and pull out the piece of nail. To prevent the nail from ever growing into the skin again, ask Dr. Shirazi about the permanent procedure option. She may take an extra pain-free step to destroy all or part of the nail root, if you are a good candidate. This is called a matrixectomy. If Dr. Shirazi removes all or part of your nail but does not destroy the root, it will begin to grow back within a few months.

After the minor procedure, it is important to take care of your toe so that it can heal. Our office will give you specific instructions to follow.

How can ingrown toenails be prevented?

You may be able to prevent ingrown toenails by wearing roomy and comfortable shoes and socks that do not press on your toes. If you work in a place where your toe might get hurt, wear sturdy shoes such as steel-toed boots to protect your toes.

Be sure to trim your toenails properly. You can do this by cutting your toenail straight across, not curved. Make sure you do not cut your toenail too short. You can also leave your toenail a little longer at the corners to help it grow over the skin.

If you have had a permanent nail avulsion, there is a 2-3% chance the nail may return. This is typically resolved with one more treatment.

If you have diabetes or peripheral arterial disease (poor circulation) talk with Dr. Shirazi before you trim your own toenails. People with diabetes have a hard time feeling their toes and might cut themselves without realizing it. Peripheral arterial disease can cause toes to be very painful.

The benefits of a Ingrown Toenail Treatment (Partial or Total Nail Avulsion) include:

The procedure is done simply in-clinic
The total appointment time typically doesn’t exceed 10-20 minutes
The procedure is performed under local anesthetic (lidocaine) so it is pain-free
You do not need to take any additional time off work/school following the procedure and can go home immediately
You do not need any special boots or braces while the toe heals
The procedure causes little post-procedure discomfort, however Tylenol can be taken should discomfort arise
We dress your toe, provide you with a take-home dressing pack and re-dressing instructions. If you need a sandal, we will provide one for you.
We monitor your progress to ensure it is healing well.

Also, be sure to ask our office about how we can help you and your loved ones trim your toenails on a bi-monthly basis. This is often covered by insurance.

Call Pasadena Orthopedics Inc. at 626-517-0022.

Fat Pad Augmentation (Leneva Injection)

...The good fat!

Fat Pad Augmentation in Pasadena, CA

Dr. Sara Shirazi is now offering an innovative procedure for patients with fat pad atrophy, painful corns, or pain at the ball of the foot. Leneva® is a procedure where an allograft adipose matrix derived from donated human tissue is used for tissue reconstruction. This is a safe and clinically proven solution to help with foot pain without steroid injections or surgery.

What is Leneva®

Leneva® is a first-of-its-kind human adipose tissue for tissue reconstruction. As an all-natural extracellular matrix, Leneva is a safe, natural, off-the-shelf solution that has multiple clinical applications including, but not limited to:

Diabetic Foot Ulcers
Pressure Ulcers
Tunneling Wounds
Fat Pad Reconstruction Procedures

Features & Benefits

Ready to use out of packaging reducing procedural preparation time
Wound treatment may allow for decreased long-term health costs from repeat patient visits due to wound recurrence
Preservation of natural derived endogenous components (matrix proteins, growth factors, cytokines) vital to adipogenesis and angiogenesis
Provides extracellular matrix that functions as a scaffold for patients own cells to create new fat
Pre-clinical studies in athymic mice demonstrate significant adipocyte formation in the host
Leneva is tested for sterility per USP<71> without the need for terminal sterilization methods

HOW IS LENEVA® DIFFERENT FROM OTHER TREATMENTS FOR FAT PAD ATROPHY?

One of the most frequent complaints we hear from new patients is painful pressure points located on the weight-bearing surface at ball of their forefoot. These pressure lesions can be caused by one or more of the following conditions: an abnormally positioned bone, toe deformities, or thinning of the fat pad cushioning the sole of the foot.

What’s so revolutionary about Leneva® is that the product organizes itself to fill in the fat deficient area, decreasing the likelihood of product displacement so that the material remains in the area where your doctor placed it. This not only provides the area with an instant fat cushion, taking the pressure off the area right away but also inserts a scaffolding that provides a space for your body to re-populate the scaffolding with new fat cells over time.

Schedule a Consultation

Call 626-517-0022 today to schedule a consultation for your Leneva® Foot Pad Augmentation treatment in Pasadena/Los Angeles. Our team can provide you with an effective solutions for any foot or ankle pain you are currently dealing with.

See our before & after side by side of a dear patient kind enough to share his results:

Diabetic Wounds & Diabetic Ulcers

What is wound debridement? Debridement is a procedure used to remove dead, damaged, or infected tissue from wounds. Wound debridement is designed for both acute and chronic wounds. Making sure to get the wound debrided helps to prevent infection. Several clinical studies recommend weekly wound debridement and they have higher rates of wound closure. Before the debridement, the office administers topical lidocaine and/or injectable lidocaine to numb the area and lessen the discomfort which can accompany the procedure.

Why does my wound have to be debrided?

Wounds can heal much faster when dead tissue is not present. Dead tissue frequently traps bacteria which can cause infections.
New tissue cannot grow when dead tissues are present. Hidden pockets of pus could lie under the dead tissue which can also cause an infection.
Infections prevent the wound from healing and can get worse. It can lead to an amputation or a life-threatening condition if it gets into the bloodstream.
Routinely removing dead tissue keeps it clean and will help the wound to grow new tissue.

How will the dead tissue be removed from my wound? There are a few ways to perform the debridement. The doctor may use one or more of them to

remove dead tissue:

Sharp debridement: This can be performed every week. It keeps the wound clean and helps it to heal quicker. The dead tissue is removed with a sharp instrument. A dressing is then applied. Occasionally, a sharp debridement will have to be performed in the operating room.
Autolytic debridement: This pain-free. A moist wound dressing is used in combination with body's ability to destroy dead tissue. This can be performed between visits. When it is used, the doctor may not have to perform a sharp debridement during the next appointment.
Enzymatic debridement: Occasionally called a chemical debridement, this is where medication is used to break down the dead tissues. It can be used in conjunction with a sharp debridement.
Mechanical debridement: Whirlpool, pulse lavage, or wet to dry saline dressings are employed. Healthy and new tissues can be affected however, so this is not used often anymore.

Skin Ulcers Q & A

What is a skin ulcer?

A skin ulcer is an open wound on the skin. It can be caused by infections, by a pressure sore, or by vein problems. Treatments will depend on the cause of the ulcer. Venous skin ulcers, the most common, are shallow wounds which occur when the leg veins don't return blood back toward the heart properly. These ulcers usually form on the lower leg, above the ankle, and beneath the calf.

What causes a skin ulcer?

Venous skin ulcers are caused by inadequate blood circulation, namely venous insufficiency. In venous insufficiency, the valves have been damaged and blood is now backing up and pooling inside the vein. Fluid can then leak out and into the surrounding tissues, resulting in the breakdown of the tissue and an ulcer. Factors that can increase a person’s risk for ulcers include:

Deep vein thrombosis
Obesity
Smoking
Lack of physical activity
Standing for many hours a day

What other types of skin ulcers are there?

Aside from venous skin ulcers, the others that can occur include:

Arterial skin ulcers occur when artery disease is present. These ulcers can be very painful. They are typically on the feet and toes.
Neuropathic skin ulcers are also referred to as diabetic neuropathic ulcers. They develop in those who have little or no feeling in the feet because of diabetic nerve damage.

How are they treated?

Initially, improving blood circulation can help. Patients can try:

Lifting the legs above the heart level frequently.
Wearing compression stockings or bandages to prevent blood from pooling in the legs.
Walking daily to improve blood circulation.

The doctor often performs a debridement to excise dead tissue from the wound. After the ulcer has healed, compression stockings should still be worn, taken off for bathing and sleeping. The doctor may advise additional treatments if needed such as:

Medication to hasten to heal or for an infection such as antibiotics.
Skin grafting, for deep or hard-to-heal ulcers.
Recommend vein surgery, which can keep ulcers from returning.

More questions or would like to make an appointment? Call 626-517-0022.