So you trim that as far deep as you can and you think you have the whole nail but you’ve left a little corner behind and that’s what’s gonna start the whole ingrown toenail process. (music) What’s going on is that we have a patient who is complaining of an ingrown toenail. She has very curved nails, as we can see, and the nail goes far down into the side on this corner. So, she has a tendency, this patient, to trim down the side to give her as much relief as possible. So that would be considered conservative treatment. So this is something that people get done at a pedicure spa, or they do it themselves, or they come in to see someone like me and we do more of some conservative treatment where we just trim down the side of the nail to kind of get that piece of the nail out of the skin and give you relief as much as possible. But if the nail is very curved and it tends to always grow into the corner, this is something that will keep coming back and that’s when we decide to do more of a permanent ingrown toenail procedure. So the normal train of thought is try to trim down the side, okay, and create a very smooth edge. The smoother the edge, the less chance it has of it poking into the skin. So that’s why a lot of educational videos are just advice in general on how to trim your toenails. They say cut straight across. The problem is if someone has trimmed the nail down the side, that corner of the nail is stuck in the skin and unless it’s taken out, it’s gonna keep bothering you. So once you start cutting down the side, you kind of get stuck trimming it over and over and over. So what I’m gonna do today is I’m gonna show this patient how to use a tool to kind of clean the corner. So what I have here, see if we can see, is a Black’s file. So it’s a very slim instrument and the backside of it, this part over here, is very smooth. That’s the part that’s gonna go against the skin and we can see the other side has little grated edges and this is what’s going to be used to act as a file to smooth that nail edge. So how this tool works is we slip tool on the side of the nail and we kind of go along the edge of it to make sure that there’s no dead skin and to make it as smooth as possible. Okay, if you feel any pain you let me know, okay? P: Okay. So what I’m doing is going down the edge to see where the nail ends and I’m gonna try to pull up. Does that hurt? A little? Yes, no? P: Yes. Yes, okay. If it’s too sore, you let me know. So I can see this nail is really ingrown. I can tell it’s really sensitive. So there’s this corner piece right here and that’s what I’m gonna work on, smoothing as much as possible. Hurts a lot? Yeah, growing into the skin right here. So I’m gonna try to smooth this as much as possible. If we can get a lot of that corner to be smooth, that nail it should be smooth, as it grows out, it won’t cut into the skin. This nail is really bugging her and it’s really tight. So what we’re gonna have to do is, we’re going to have to trim down the side. Okay? To create more space between this edge and the skin. If we can cut down here and make them push the nail away from the skin, it won’t irritate it. But the difference that what we’re gonna do is we’re gonna use this tool to smooth that cut after I’m done to try to prevent a rough edge from cutting into the skin. So that’s the big difference. A lot of people tell you don’t cut down the side. If you can avoid it, great. But if you do, having a tool like this will help clean out that corner so it’s not so painful. I’m just going to trim the nail down the side, okay? If it gets really sensitive, you let me know. Okay. I can’t do it in this position. So we trim down the corner, okay, and now I’m trying to smooth the edge so there’s no rough point and I can see with this tool that there’s a little corner left behind and that’s why this tool is pretty helpful for me to see if there’s a piece that’s left behind. So you can see there’s a lot of dead skin coming out. This tool helps make sure that the whole nail sulcus is clear, no dead skin is building up, and to smooth any edge that’s left behind. Okay. Last little piece that I see, you can see here, coming out, last little piece. Not a good position for me. Let me lift the foot back up like this. So that corner was really stuck in here and she’s been having a hard time treating this and even me, with my sharper tipped nail nippers, trying to get all the way to the end of the nail is very hard. So you trim that as far deep as you can and you think you have the whole nail but you’ve left a little corner behind and that’s what’s gonna start the whole ingrown toenail process. So now I can actually get around to the edge of the nail, I can see the very very end and I’m smoothing it out as much as I can. Does this hurt you with me doing this? P: No. Okay, very good. So as you can see, it’s not hurting her as much. It’s not as sensitive because that piece is kind of gone. I’m cleaning this corner; I’m down at the very edge. So I’m at the very end of where I made my cut and I’m using this tool to clean the corner as much as I can. The smoother I get this, the healthier the nail will grow out and hopefully not have a spike to cut into the skin again and cause discomfort. If this problem keeps happening, this is when we suggest doing something a little bit more permanent, so this doesn’t come back. So you can see it just pulling out dead skin, all the build-up of callus, dead skin, nail dust from me filing it down. So now I can go in here nice and smooth, go around the nail edge. Does this hurt? P: No. TB: Okay. Good. The last little bit, so it’s very deep in here and that’s what happens when you pick around here too much. So that’s why you guys, a lot of people end up coming in here because they’ve tried to dig it out. They thought they’d cut to the edge of the nail; they didn’t left a little spike. So by having this tool, you can go to the very end of the nail, check the side, no issue. So if I go on this side, I can see the end of the nail all here. It’s hard for you guys to see because I don’t have it going very close but I can see the very end of the nail. There’s no rough edges. It’s a little tender for her so I’m just gonna smooth it up and down just like a file you’d use on hard skin but it’s doing it on the nail itself and this is gonna create more of a space between the nail and the skin and that way as the nail grows out. It doesn’t push against the skin and that’s gonna help give you some relief. So you can see that dust that’s coming out. That’s just actually the nail dust from me filing the nail. So this will be really helpful for a lot of people to check the corners to make sure they have no speck left behind, to clear out the corners, very, very deep in here. Very deep. Is there pain, if I push here? Does it hurt? A little bit? Tender? Well we just poked around a little bit. So this should be much better because now I can put my tool in here; there’s a lot more space. The goal is to keep filing this nail now, allow the nail to grow out, but keep it rounded so then we don’t have to cut down the side again. If you look at this toe, it’ll be interesting to see. We can see the nail edge is quite exposed, different and we see a line here and so this is a sign that she’s had an ingrown toenail procedure done before; she had it when she was a teenager and this is a different procedure than what I do. What they do here is they cut all the way down, cut out the nail matrix itself, and then put a little stitch so everything closes up. So that’s why there’s a different kind of scar here because they actually cut this all open and took out the nail matrix itself physically instead of using a chemical.
So we can see the nail stops growing at that line; nothing grows past here. No more ingrown. So the nail edges is nice and free . You can see I can put the tool and this is actually a good way to look at what I’m doing inside or when the nail is stuck in the skin is I’m just pushing it against the side of the nail and up and down. Just filing it. So we’ll check this side. Again, very curved nails but I can see the edge here and it’s again very sensitive for her because the nail is tight. So to me, going in here, cleaning the corner, pulling out dead skin. So you want to go from the bottom and pull to the top and this is what’s gonna allow you to take out dead skin, smooth the edge of the nail create, more space between the nail and the skin and this is gonna help give you more relief from really curved nails and making sure that there’s no rough edge or nail spike. So again, really important for people with ingrown toenails or curved nails to have some sort of tool to clean the edge of the nail so there’s no rough spikes, if you do cut down the side, create more space between the nail and the skin, and help remove some of the dead skin buildup that also can cause a lot of pain. By keeping the nail sulcus free, it helps really reduce a lot of pain that people feel from pressure. So again, you use the smooth side of the Black’s file against the skin, so there’s nothing sharp, and then you push against the nail edge, and you pull forward; in, out. Just like that. Okay, so let’s see if I can get an up-close view. So there’s a deep groove and I’m able to go to the very end of where I made my cut and pull forward. So now this channel is smooth. The edge of the nail, right here where I finished my cut, is smooth. There’s no jagged point that goes in. So as this grows out, it should be relatively smooth. Same with here too. Go to the nail edge, you slip it underneath, then you pull it forward and this will help clean the nail sulcus and make sure there’s no rough corner. You can also use it on the corner of your nails, like this, to just round that final edge. So nothing’s sharp. So I’m just gonna wipe it down with a little alcohol and that’s how sometimes we treat ingrown toenails conservatively. Smooth that nail edge, so as this nail grows out, because it’s rounded, it won’t cut into the skin. It moves up and now we can start cutting it straight across. If we can leave the tip, the edge of the nail, above the skin fold, very good. Anytime we cut low, like this, that’s where we run a risk of leaving a nail spike and that growing into the skin itself. So filing that edge, nail edge, smooth really helps promote a healthier straighter and smoother nail to grow out without cutting into the skin.