Incision & Drainage (I&D)


Incision and drainage is a procedure performed on infected toenails, such as paronychias. When performing an incision and drainage (I&D) on an infected toenail, it usually does not involve an actual incision. Toe infections are perhaps the most common foot infections but all infections need immediate attention. Oral antibiotics, incision and drainage, along with caring for the wound are necessary to get the quickest and best outcomes. Many medical conditions such as diabetes, poor circulation (PAD, PVD), edema/swelling, lupus, and neuropathy are but a few examples that may slow wound healing.   Medications such as Coumadin / blood thinners, steroid and chemotherapy are also only few drugs that may slow the healing process. Drugs that cause edema (see topic) may slow healing and facilitate infection.


The procedure for I & D of a toe is outlined below:


1) The toe with the infected toenail is numbed with local anesthetic at the base of the digit in order for the patient to be able to tolerate the drainage of the infection.


2) A small sliver of toenail from one or both sides (and sometimes the entire toenail) is removed. When the portion of the nail is appropriately removed, the nail border or nail bed is inspected for any remaining pieces of toenail that may be causing infection to be present.


3)  All pus and fluid is drained from the nail and disinfected.


Note: That when infection is present, a chemical matrixectomy is not usually performed at the same time. It could cause the infection to spread. If any residual infection decides to invade the area of the chemical destruction of the nail cells, it could lead to a more serious infection and possible invasion of the bone underneath the nail plate.


It should also be noted that patients who have an I&D performed must realize that there is a high probability that the nail border may come back ingrown again. Therefore, it is important to return to our office before the toenail becomes infected again and have a chemical matrixectomy performed. This will ultimately prevent re-growth of the ingrown toenail.  I have seen a 99% success rate with this procedure!


If you have an infected toenail, please call 954-987-0550 to schedule an appointment immediately.