What is an ingrown toenail and how is it caused?
Onychocryptosis, more often called referred to as an ingrown toenail, is a common nail pathology generally effecting the big toe (Eekhof et al. 2012). An ingrown toenail occurs when a nail spicule pierces the surrounding skin creating a portal of entry for bacteria. This can result in infection, inflammation, and the development of a severely painful lesion (Eekhof et al. 2012).
Who do ingrown toenails effect?
Ingrown toenails are an incredibly common cause of foot pain. It is reported that up to 20% of patients presenting with foot problems have an ingrown toenail (Heidelbaugh & Lee 2009). The peak incidence of ingrown toenails is amongst patients aged between 13 to 29, and the condition effects males in a 2:1 ratio compared to females (Ezekian et al. 2016).
Further, predisposing factors such as improper nail care, poorly fitting footwear, genetic predisposition, hyperhidrosis, and trauma also play a role in contributing to the incidence of an ingrown toenail (Ezekian et al. 2016; Heidelbaugh & Lee 2009).
How do we treat an ingrown toenail?
Ingrown toenails can be classified into three stages: Mild, moderate, and severe (Eekhof et al. 2012). A range of conservative and surgical treatment options are available depending on the stage of development.
In the case of mild to moderate ingrown toenails conservative management is often appropriate. These non-surgical treatments aim to alleviate symptoms, prevent the nail from worsening, resolve the problem, and prevent recurrence (Heidelbaugh & Lee 2009). However, if the ingrown nail is in the moderate and severe stages surgical treatment may be required. Treatment involves a minor surgical procedure called a Partial Nail Avulsion. This intervention aims to permanently remove the offending section of nail (Eekhof et al. 2012).
A Partial Nail Avulsion is minor procedure done in the clinic. During the procedure a local anaesthetic is given, and the offending section of nail is completely removed. To ensure the removed section does not grow back, causing another ingrown toenail, a technique called phenolisation is used (Karaca & Dereli 2012). Phenolisation involves applying a chemical to the nail matrix – where the nail williamgrows from, causing matrix destruction and thus preventing nail growth (Khan et al. 2014). Phenolisation of nail matrix has been considered the most effective technique for definitive treatment of ingrown toenails with a recurrence rate as low as 0-4.4% (Khan et al. 2014; Di Chiacchio 2010). Once the procedure is complete there is often minimal post-op pain and completed healing can be expected in approximately 4-8 weeks (Solanki P & Craike P 2011).
References
Di Chiacchio N, Belda W, Di Chiacchio NG, Gabriel FVK & de Farias DC 2010, ‘Nail Matrix Phenolization for Treatment of Ingrowing Nail: Technique Report and Recurrence Rate of 267 Surgeries’, Dermatologic Surgery, vol. 36, no. 4, pp. 534-537.
Eekhof JAH, Van Wijk B, Knuistingh Neven A & van der Wouden JC 2012, ‘Interventions for ingrowing toenails (Review)’, The Cochrane Library, vol. 4, pp. 1-84.
Ezekian B, Englum BR, Gilmore BF, Kim J, Leraas HJ & Rice HE 2016, ‘Onychocryptosis in the Paediatric Patient: Review and Management Techniques’, Clinical Paediatrics, vol. 56, no. 2, pp. 109-114.
Heidelbaugh JJ & Lee H 2009, ‘Management of the ingrown toenail’, American Family Physician Journal, vol. 79, no. 4, pp. 303-312.
Karaca N & Dereli T 2012, ‘Treatment of Ingrown Toenail With Proximolateral Matrix Partial Excision and Matrix Phenolization’, The Annals of Family Medicine, vol. 10, no. 6, pp. 556-559.
Khan IA, Shah SH, Waqar SH, Abdullah MT, Malik Z & Zahid MA 2014,’Treatment of Ingrown Toenail – Comparison of Phenolization After Partial Nail Avulsion and Partial Nail Avulsion Alone’, Journal of Ayub Medical College Abbottabad, vol. 26, no. 4, pp. 522-525.
Solanki P & Craike P 2011, ‘Partial nail avulsion: habit or evidence based?’, Journal of Foot and Ankle Research, vol. 4, no. 1.