Fear, anxiety and uncertainty sometimes keep people from getting the care that would otherwise improve their health, comfort and lifestyle. Here are some of the common things people worry about in regards to visiting the clinic:
Maybe you’ve had a bad experience in the past where the injection was painful or didn’t seem to “kick in” until after the procedure was finished. The injection to numb your toe is placed at the base of your toe – not under the nail or at the tip of the toe. Additionally, I use a cold spray, Ethyl Chloride, that briefly numbs the skin while the needle is inserted. Unfortunately there is no way to take away the sensation of the medicine going into the tissue, but children as young as 8 have tolerated it very well in the office. Once the the anesthetic has been injected, we wait.
Once the anesthetic has taken hold, there is no pain. It may feel strange, odd, or like a deep pressure, but should not be painful. You can lay back, put your earbuds in if you’d like, and it will be over before long.
Immediately after the procedure you can put your socks and shoes on and walk. If you drove yourself to the appointment, you can drive yourself home. While your toe is healing, there are a few things you’ll be instructed not to do, like going for a swim, walking barefoot at the beach, or soaking in a hot tub. But for the most part, you’ll be able to get back to your normal activities right away. Heavy activity early on may cause increased pain or slow healing, but it won’t be detrimental to the long-term outcome.
You’ll get a handout that describes how to care for your toe. Initially you’ll need to take care of it morning and night. If you have especially sweaty feet or are involved in sports you may need to clean it three times a day to reduce the likelihood of getting an infection. But for most people, two times a day is sufficient. If only part of the nail was removed, the healing period typically lasts 7-10 days. However, it may take a few weeks if the entire nail was removed or if there was infection. During this healing time you should be able to participate in things you normally do, but just plan a bit more time at the start and end of your day to care for the toe.
If the border of the nail is removed from a big toe, generally the appearance of the nail and/or toe changes very little. The majority of what is removed is the part of the nail that is tucked in the nail fold. Over time it can be difficult to even remember what part of the nail was removed. If, however, your situation requires the entire nail to be removed, then you will begin to notice some changes in the shape of the toe over time. Toenails help stabilize the soft tissue at the tips of our toes. Without the nail on the toe, the pressure of walking will, over the course of the years, push the soft tissue upward a bit. Because of that, it’s common for toes to take on a more rounded appearance after a toenail has been removed. However, if the option is a more rounded toe tip or chronic infections, swelling and pain, most people choose the rounded toe tip.
First off, the injection isn’t right for everyone and it’s never required. Now that that’s out of the way, let’s talk about it. Pain on the bottom of the heel is often caused by inflammation of a ligament on the bottom of your foot. That’s called plantar fasciitis. Other times the pain may stem from an inflamed bursal sac, called bursitis. And still other times it may be a nerve that’s being compressed and radiating pain. If an injection is appropriate for your situation, there are some good reasons to consider having it done. A steroid injected directly into the area works as a strong anti-inflammatory. That means it can reduce the swelling and thickness of the tissue in the area. It helps get things back to normal. There seems to be a common mis-conception that steroid only masks the problem, but it actually helps relieve the problem. It can be a helpful piece of the puzzle, but it’s not a cure-all. And it’s not required. Helpful, but not required.
Orthotics are custom made devices that go in your shoes to correct alignment problems that may be contributing to your pain. For people with mild alignment problems, appropriate over-the-counter inserts and correctly selected shoes are often adequate. Maybe not perfect, but good enough to relieve the pain. And for most people, that’s a satisfactory end point. If your structure needs more of a boost, then custom orthotics may be the answer. Your doctor can point you in the right direction. And they may not be as expensive as you fear.
Well, maybe there is something that can be done. Even if you’ve been to the doctor before and didn’t find any relief, it doesn’t mean there is no help available. For being a relatively small part of our bodies, feet have a lot of moving parts. Some problems are complicated, elusive, and hard to solve. Perhaps the first treatment path didn’t improve the situation. That’s a great piece of information to have, and helps direct the next step.
If it’s impacting your quality of life, it’s important. Yes, there are terrible things that can happen to a person and your foot pain is probably not one of those. But that doesn’t mean it doesn’t matter or that your life wouldn’t be more enjoyable if you got it taken care of.
You might be surprised at the ways we have to take care of toenails. There are many treatments available to improve nails. Only in the most severe situations is the recommendation made to remove the nail permanently. Even less often is it recommended to remove the nail temporarily. During the process to remove a nail, the nail root can be disrupted and damaged. That damage increases the likelihood that the nail structure will be worse over the long-haul if you take the nail off temporarily. So let’s leave the nail on if we can, and find a way to make it healthier and pain free.
If it doesn’t look right, feel right, smell right, or if it’s otherwise concerning or painful… it’s not a waste of my time.Treating basic foot problems is what I do.
My insurance won’t pay for it. Well, you might be right these days, but isn’t it worth checking? Some things insurance routinely pays for are ingrown toenail treatments, injections, and wart removal. Some things insurance rarely or never pays for include orthotics for flat feet and laser treatments for fungal toenails. And some things that require specific risk factors before insurance will consider it medically necessary include nail and callus care, and diabetic shoes. If you come in for an evaluation, the doctor and staff very well may know if your insurance will allow for the charges in question. If not, they can provide you with diagnosis and treatment codes relevant to you so you can contact your insurance and get the desired information.