Nerve pain after toenail removal (removed over 1 year ago)

by Larry
(South Texas)

I had my toenail chemically removed over 1 year ago. Since the toenail removal I have had pain (they tell me it's nerve pain) and numbness in my big toe. I have had the area where my big toenail was removed checked out by an MD and a podiatrist (VA). The best the podiatrist could offer was some urea lotion and he offered to surgically remove the skin (postage stamp sized) where the toenail used to be. The podiatrist admitted that he was not certain what the outcome of this skin removal would be. I am a good sport but not a guinea pig. The pain keeps me awake at night and wakes me up at the slightest touch. The weight of a comforter will accomplish this. The VA has offered to send me back to the same podiatrist knowing I would like a second opinion. For those of you who know how fast the VA works this is not an option.I am hoping that somebody may have encountered this and actually healed the problem with a real treatment that you know the outcome of (preferably positive). Wearing shoes doesn't bother me as much because my toenail area does not contact my shoe directly.

Any input or help would be greatly appreciated.

RESPONSE

Hi Larry,

Like most podiatrists I have done hundreds if not thousands of chemical matrixectomies in my career. I cannot say I have ever experienced a situation such as you are experiencing.

Every now and then a patient will end up with a neuritis which is an inflammation of a local nerve. This is usually caused by trauma to one or more nerves going into the toe, simply from the needle accidently hitting the nerve during the injection.

Since injections are given blindly, it is not uncommon to occasionally hit the actual nerve with the needle.

What generally happens is a few days after the procedure, the patient will notice isolated spots of numbness, tingling, or perhaps burning which represents localized damage to one of the four proper digital nerves that run into the toe, usually one of the two bottom nerves as they are the ones that innervate the nail bed.

Since the problem is the result of direct needle trauma to the nerve, this problem will generally resolve itself over time, certainly by one year down the road.

So in your case you had your procedure done over a year ago and you are still having problems. If I understand your narrative correctly it sounds like the area of discomfort is the nail bed, the area where the nail used to be located.

After a matrixectomy the nail bed usually "hardens" up and is no more or less sensitive then a toe with the nail still attached.

Because the podiatrist had given you urea cream I am guessing there must have been some hard tissue of some sort over the nail bed. Not sure if that is part of your problem or not. I would say this, if the urea cream helped even a little bit, I would go back to a podiatrist and have him debride (scrape) the excess tissue off the top of the toe, not actually removing all the skin but just the excess skin.

Besides the possibility of nerve damage from the needle, the only other thing I can think of that would cause your symptoms is if the chemical applied to the nail matrix was too strong and you ended up with a chemical burn. Even if that is the case, at a year, it should be much better, perhaps not perfect.

As you can see, I am "grabbing at straws" simply because I cannot actually examine you and see whats going on.

The best advice I can give you from the other side of the internet is to see a different podiatrist then the one you originally saw in an effort to get a different perspective on your problem.

I am not sure if this will work or not, but you could ask your doctor about applying small lidocaine patches to the top of the toe. This will not solve your problem but it may dramatically reduce your symptoms.

Marc Mitnick DPM
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