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Ingrown toenails: digging out the facts

The best method for treating patients with an ingrown toenail has long been debated. Non-surgical options are generally preferred for patients with mild-to-moderate symptoms, and surgical options preferred in patients with more severe symptoms. However, there is limited evidence available regarding the effectiveness of non-surgical treatments. Recent evidence suggests that some surgical techniques are associated with very low recurrence rates of the ingrown toenail, and therefore should be considered more often, despite being a more invasive treatment.

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 Trick of the Trade: Toe paronychia splinting

Alternatively, you can slide an 18-gauge angiocatheter (just the plastic part) into the potential space. The new nail should then grow over this plastic “splint”. The added benefit of the angiocatheter over the cotton is that if you needed to remove it for whatever reason, it’s easier to remove as one piece than cotton.

Articles of Interest

A Conservative Method to Gutter Splint Ingrown Toenails

In conservative approaches for treating ingrown toenails, lifting the nail plate out of the ulcer bed using the gutter technique improves wound healing. There is no need to free the side of the nail plate all the way to the proximal nail fold or matrix. Pushing a plastic gutter between the nail edge and the ulcer bed is all that is necessary and usually does not require anesthesia.

A Minimally-Invasive, Simple, Rapid, and Effective Surgical Technique for the Treatment of Ingrown Toenails: A Reminder of the Original Winograd Procedure

Among the various surgical treatments for ingrown toenail, the Winograd method is a popular technique that has been used frequently since 1927, and entails partial nail plate excision and curettage of nail bed and germinal matrix. In an effort to avoid recurrence, such minimally invasive procedures have been modified over the years to include wedge resection of the nail fold and complete ablation of germinal matrix...

Controversies in the Treatment of Ingrown Nails

Judging from the literature and own experience, selective matrix horn resection is the surgery of choice; which modality is used is of secondary importance provided it is radical enough. Recurrence rates vary in the literature reflecting different levels of experience.

Ingrown Toenail Management

There are three stages of ingrown toenails. Stage I includes erythema, slight edema, and pain when pressure is applied to the lateral nail fold. Stage II includes the stage I findings plus signs of infection and a purulent drainage. Stage III is a magnification of the two previous stages with the addition of granulation tissue formation and lateral nail fold hypertrophy.

Ingrown toenails: the role of the GP

If conservative care proves unsatisfactory or if the patient presents with a recurrent ingrown toenail then surgical treatment is indicated. Sharp nail resection and phenol-ablation techniques have been reported in the literature as safe and effective methods for treating ingrown toenails. The Winograd technique is perhaps the most commonly performed sharp procedure and is often used when a hypertrophied nailfold is in need of excision. Winograd, a US podiatrist first described the technique in 1929.

Management of the Ingrown Toenail

Although clinical trials proving its value do not exist, conservative therapy is a reasonable approach in patients with a mild to moderate ingrown toenail who do not have significant pain, substantial erythema, or purulent drainage from the lateral nail edge.

Practice tips. Toenail splinting

Inserting cotton splints to treat ingrown toenails.

Train Yourself: Ingrown Toenail Removal Trainer

We set out to create an affordable trainer to teach the procedure in a simulation setting.

Trick of the Trade: Toenail splinting for ingrown toenails

Is there a less invasive method for treating an ingrown toenail? Tuck the cotton into the nail sulcus, gently tucking it under the lateral free edge of the nail. This will keep the nail lifted during subsequent growth. Can also use a curved hemostat for this step.

Resources

OrthoInfo

An ingrown nail occurs when the skin on one or both sides of a nail grows over the edges of the nail, or when the nail itself grows into the skin. Redness, pain and swelling at the corner of the nail may result and infection may soon follow. Sometimes a small amount of pus can be seen draining from the area.

StatPearls

Taping procedure: One end of the tape gets placed against the side of the ingrown toenail, with the rest twisted around the toe. The aim is to pull the side of the nail fold away from the nail to decrease pressure. Taping is the safest and least painful procedure among conservative options.