Ask Dr. Etingin: Carpal tunnel syndrome; Ingrown toenail solutions

I’ve been diagnosed with carpal tunnel syndrome. Is surgery my only option?

If tingling, numbness, or pain in your hand, as a result of carpal tunnel syndrome, is affecting your ability to sew, garden, or do other hands-on activities, there are several treatment options to consider. The primary goal is to relieve pressure on the median nerve, which runs through the carpal tunnel in your wrist.

Conservative treatments are usually recommended first. Splinting with a wrist brace, especially at night, prevents further irritation of the median nerve. The brace looks like a fingerless glove that has a rigid support that keeps the wrist in a neutral position. You can buy one at your local drug store, which makes it an excellent first step. However, it may take weeks to see improvement, and the relief might be minimal. Corticosteroid injections offer a more direct approach by reducing inflammation and swelling in the carpal tunnel. These injections can provide significant relief; however, the effects can be temporary, and repeated injections are generally not recommended due to potential side effects like weakening of the surrounding tissues. Acupuncture can also be an effective alternative for managing carpal tunnel syndrome; however, it is generally considered less predictable compared with traditional methods.

For persistent or severe cases, surgical intervention might be warranted. Carpal tunnel release surgery involves cutting the ligament pressing on the median nerve, thereby relieving pressure. This procedure has a high success rate and can provide long-term relief, but it may take several months for full strength and sensation to return.

Ultimately, the best treatment depends on the severity of your symptoms and how they affect your daily life. Discuss your options with an orthopedic specialist, who can tailor a treatment plan that’s best for you, ensuring that you can continue to enjoy your activities pain-free.

I generally take care of my feet, but no matter what I do I cannot escape an ingrown toenail on the third toe of my left foot that keeps coming back. What can I do?

A recurring ingrown toenail despite a diligent foot-care routine can be frustrating and painful. The primary reason for this persistent issue often lies in the way the nail grows or how pressure is applied to the toe. Factors like tight-fitting shoes, improper nail trimming, or even genetic predispositions can contribute to the problem. In some cases, repeated activities that put stress on the nails—such as an exercise routine that includes running—can exacerbate the condition.

First, ensure proper nail care. Trim your nails straight across, avoiding rounded corners, which can encourage the nail to grow into the skin. Opt for comfortable, well-fitting shoes that provide ample toe space. If these measures do not resolve the problem, soak your foot in warm water several times a day to help reduce swelling and alleviate pain.

If you have tried all of these measures and none are effective, it’s probably time to consult a foot specialist. A podiatrist can assess the situation and may recommend procedures like lifting the nail to allow it to grow out properly or, in more severe cases, removing part or all of the nail in a minor surgical procedure called a partial nail avulsion. This involves removing the problematic section of the nail and sometimes the underlying nail bed to prevent regrowth in that area. The procedure is quick and done under local anesthesia, providing long-term relief with minimal risk. Consistent follow-up care and adhering to your podiatrist’s advice can help prevent future occurrences.

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