Overgrown Toeskin or Ingrown Toenail?
An Evidence-Based Approach to Treating Toe Problems
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Do you have a question about Overgrown Toeskin, Ingrown Toenails or Toe Surgery?
Please review the questions below before contacting us. If your question regarding overgrown toeskin or ingrown toenails is not answered here please contact us and we will do our best to reply to your question in a timely manner.
What is Overgrown Toeskin vs an Ingrown Toenail?
Overgrown toeskin is a problem where there is too much skin aournd the nail - the nail is not the problem. That's why we call it "Overgrown Toeskin". The skin piles up around the toenail and the nail is normal.
A study done on the nails shows that there is no difference in the nails of patients with Overgrown Toeskin (ingrown toenails) compared to a group of patients who do not have the problem.
Ingrown toenails are nails that are visibily curled in on the sides. The nail is noticeably abnormal.
What causes Overgrown Toeskin?
Overgrown Toeskin is caused by weight-bearing (activities such as walking, etc.) in patients that have too much soft tissue (skin) along the sides of the nail. Weight bearing causes this excessive amount of skin to bulge up along the sides of the nail. The pressure on the skin around the nail causes the toenail to dig into the excess skin and the tissue becomes damaged. This causes swelling, redness and infection.
Is there any way to prevent Overgrown Toeskin?
Patients that have too much tissue along the sides of the nail are at a high risk for Overgrown Toeskin. Cutting the nail too short, especially along the sides, can cause further bulging of the skin with weight-bearing. This increases their probability of developing Overgrown Toeskin.
Not cutting the nail too short may help to alleviate some pain associated with the Overgrown Toeskin, but this will not cure the problem.
What are the treatment options for Overgrown Toeskin?
In the past (and unfortunately still today) the most common treatments are mainly directed at the nail. Treatments often include removal of part or all of the nail. However, if the nail is normal and the overgrown toeskin is not treated, these procedures often result in the problem returning or in deformity/mutilation of the nail (see the Photo Gallery).
The other option is a treatment that is directed at the soft-tissue and leaves the nail untouched (the Vandenbos Surgery).
What is the best treatment for Overgrown Toeskin?
The best treatment for Overgrown Toeskin is the Vandenbos surgery, a procedure that treats the excess tissue (skin) along the sides of the nail and leaves the nail untouched.
Removing all or part of the nail has a 70% failure rate for patients with Overgrown Toeskin. Dr. Chapeskie has performed the Vandenbos surgery on nearly 2000 toes with no known recurrences.
Why should the Vandenbos Surgery be used instead of other treatments?
Unlike other procedures used to treat Ingrown Toenails, the Vandenbos Surgery does not touch the nail. This means that the nail looks normal after the surgery. Excellent cosmetic result is achieved for the toe.
Other procedures can leave the nail deformed and the problem usually returns. Surgeries that remove all or part of the toenail for patients with Overgrown Toeskin can lead to a higher chance of infection, requiring the use of antibiotics and most often do not fix the problem. Removing all or part of a normal toenail often results in poor cosmetic appearance.
The Vandenbos Surgery has been very successful - Dr. Chapeskie has had no recurrences and all patients have had excellent cosmetic results!
If the surgery is performed correctly, with a generous amount of soft tissue removed, the problem will not recurr. If a recurrence does occur, it is most likely because the physician did not remove enough soft tissue around the nail the first time the surgery was done.
How long does the Vandenbos Surgery take?
The actual surgery takes about 20 minutes for one toe and 30 minutes for two toes.
However, you can expect to be in office for approximately 1-2 hours for reviewing consent, after care, etc.
How successful is the Vandenbos Surgery? Will my Overgrown Toeskin come back?
The surgery was first described by Vandenbos and Bowers (1959). They had no known recurrences. Vandenbos and Bowers performed and reported on 55 patients.
Dr. Andrew Chapeski performed over 200 Surgeries in over 35 years with no known recurrences.
Dr. Henry Chapeskie has done over 1100 Surgeries (about 2000 toes) in over 25 years with no known recurrences.
If the Surgery is performed correctly, the problem will not return!
*However, this surgery cannot fix a nail that has already been damaged from previous nail surgery.*
Is there anything I should do to prepare for the Vandenbos Surgery?
Yes. Your doctor may give you a prescription for pain medication for after the surgery - it is a good idea to pick this up before the surgery so that you have it ready for when you get home.
Also, you need to arrange for someone to drive you to the clinic and to pick you up after the surgery.
Your doctor may give you a handout on preparing for your surgery. You can see a sample of Dr. Chapeskie's handout here. It is important to follow the instructions your doctor gives you before surgery.
I have Raynaud's Phenomenon, Diabetes, or poor circulation in my feet. Can I still have the Vandenbos Surgery?
Yes. You can still have the Vandenbos Surgery (or a nail surgery) if you have one of these conditions. It is very important to mention this to your doctor, however, since they may use a different freezing on your toe or recommend something different for you.
Dr. Chapeskie has done toe surgeries on many people with diabetes. As long you have good pulses in your feet, you can have toe surgery without any modifications. Again, it is important to mention this to your doctor to make sure the procedure is safe for you.
How do I care for my toe(s) after surgery?
It is very important to follow your doctor's after-surgery care instructions as this is essential for proper healing of your toe.
You can Click here to Download Dr. Chapeskie's Patient Instructions for after the surgery.
You can CLICK HERE for a video on Preparing for Your Surgery, including aftercare instructions.
Where can I get more informaiton on the Vandenbos Surgery?
You can ask your doctor about the Vandenbos Surgery or Contact Us for more information. You can also review some of the Research articles on this topic.