"I am tired of wearing Birkenstocks with everything I own", was how Marlene explained why she decided to seek care of her ingrown nail.

Marlene is an emergency room nurse. Her job requires her to work on her feet for hours at a time. And for every one of those hours her foot hurt. More specifically, her right big toe hurt. Sometimes it was swollen, red and hurt and other times it just hurt. This went on for years. When it got particularly bad she would soak the foot and take antibiotics. This brought down the pain from wild to mild. When it did not hurt so bad she merely limped. It hurt nearly all the time. Marlene did not know what most of the readers of this column know: that fixing this problem permanently in a podiatrist’s office is quick, slick and close to painless.

Contrary to popular opinion, ingrown nails are not usually due to improper cutting of the toenails. The usual cause is a nail shape that is incompatible with the shape of the toe, especially when confined in a shoe. The more recurrent the ingrown nail or the longer it has persisted, the more likely that the shape of the nail is the culprit. I have seen nails that were the "U"-shaped, shaped like a staple or hooked on one side. When these nails hurt it is almost entirely due to their shape.

To make matters worse, nails tend to get more curved and thicker as we go through life. Even if the nail starts out well-shaped, they can curve enough to hurt as we approach middle age (which, from my perspective, is getting later and later and is now between the ages of 60 and 80!). I have no idea why our nails have to get more curved as we go through life. It is on my list of questions to someday ask the Master Designer (along with why cars break down only after the warranty runs out, how single socks manage to escape from the washer and why the Ventura freeway traffic needs to come to a stop at Tampa Blvd.).

Ingrown nails caused by the shape of the nail are mainly painful. They are seldom the red and draining kind that look infected. The latter are more characteristic of the ingrown nails of teenagers. I say look infected rather than are infected because even the worst looking nails are more a product of a foreign body reaction than an infection. The nail plate, like hair, is an external structure. When the nail plate cuts into the skin your body does everything it can to get rid of it. It sends in white blood cells (pus) and red blood cells (blood) and inflammatory fluid (swelling) to eliminate the offending nail. Eliminating the offending nail edge, and not antibiotics, is the key to relief. This is usually done under gentle local anesthesia.

After gentle local anesthesia I removed a tiny edge of Marlene’s toe nail. The piece I removed was so thin that no one except she and I could tell any nail was removed. I knew she would feel better immediately. Because Marlene had a long history of ingrown nails I could safely assume that when the nail grew out it would be ingrown again. To prevent this from happening I added a little bit of chemical into the area where I removed the nail. The chemical will inactivate a portion of the nail root and prevent the misshapen edge of the nail from ever growing again. The visible portion of the nail is left alone and is neither removed or damaged. I bandaged the toe and sent her home to rest her foot for a few hours. The following day she redressed her toe with a Band-aid and was back at the emergency room saving lives. This time without pain for the first time in almost a decade.