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ingrown toenail; onychocryptosis; unguis incarnatus
Etiology:
- occurs when the nail plate grows into the periungual skin
- footwear are most often contributory factors [3]
- repetitive toe trauma (e.g., running, kicking)
- hyperhidrosis & onychomycosis may be contributary [3]
Epidemiology:
- 20% of foot problems in primary care [3]
- occur most commonly in young men [3]
Pathology:
- periungual skin of the lateral nail fold is traumatized by adjacent nail plate, resulting in an inflammatory foreign body reaction
- inflammation & infection of the periungual skin [3]
Clinical manifestations:
- painful, draining, foul-smelling lesion
- hypertrophy of the involved nail fold
- pain, discomfort, & disability if left untreated
Radiology:
- X-ray to rule out osteomyelitis if a consideration
Management:
1) ingrown nails may be nonsurgically or surgically treated
2) soaks & antibiotics for acute infection
3) non-surgical approach for mild-moderate cases
a) correct inappropriate footwear
b) manage hyperhidrosis & onychomycosis
c) soak affected toe, follow with application of a medium-to-high potency topical glucocorticoid
d) place wisps of cotton or dental floss under ingrown lateral nail edge
e) application of a gutter splint (image [3]) to the ingrown nail edge to separate it from the lateral fold provides immediate pain relief
f) a cotton nail cast made from cotton & cyanoacrylate adhesive, taping the lateral nail fold, or orthonyxia may also alleviate mild to moderate ingrown toenail [3]
4) indications for surgery:
a) stage 1: erythema & swelling of the lateral nail fold
b) stage 2: infection with edema & drainage
c) stage 3: formation of granulation tissue with hypertrophy of lateral nail fold [3]
3) surgery (images [3])
a) remove the interaction between nail plate & nail fold
b) eliminate local trauma & inflammation
c) toenail avulsion
- partial avulsion of the lateral edge of the nail plate
d) wedge incision of nailfold
e) matrixectomy further prevents recurrence
- surgical, chemical, or electrosurgical procedures [3]
- avoid chemical matrixectomy in uncontrolled diabetes mellitus. peripheral vascular disease & pregnancy (avoid phenol) [3]
f) postoperative use of antibiotics, manuka honey, povidone-iodine with paraffin, hydrogel with paraffin, or paraffin gauze does not improve infection rates, pain, or healing time [3]
Related
ingrown toenail avulsion; Zadek's procedure
toenail
General
nail disease
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 985-86
- Vlahovic TC
The Ingrown Toenail: Etiology and Management.
VuMedi. April 12, 2023
https://www.vumedi.com/video/aad-2023-management-of-ingrown-nails/
- Mayeaux EJ Jr, Carter C, Murphy TE.
Ingrown Toenail Management.
Am Fam Physician. 2019 Aug 1;100(3):158-164.
PMID: 31361106 Free article. Review.
https://www.aafp.org/pubs/afp/issues/2019/0801/p158.html