ingrown toenail; onychocryptosis; unguis incarnatus
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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
- ingrown nails may be nonsurgically or surgically treated
- soaks & antibiotics for acute infection
- non-surgical approach for mild-moderate cases
- correct inappropriate footwear
- manage hyperhidrosis & onychomycosis
- soak affected toe, follow with application of a medium-to-high potency topical glucocorticoid
- place wisps of cotton or dental floss under ingrown lateral nail edge
- application of a gutter splint (image[3]) to the ingrown nail edge to separate it from the lateral fold provides immediate pain relief
- 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]
- indications for surgery:
- stage 1: erythema & swelling of the lateral nail fold
- stage 2: infection with edema & drainage
- stage 3: formation of granulation tissue with hypertrophy of lateral nail fold[3]
- surgery (images[3])
- remove the interaction between nail plate & nail fold
- eliminate local trauma & inflammation
- toenail avulsion
- partial avulsion of the lateral edge of the nail plate
- wedge incision of nailfold
- matrixectomy further prevents recurrence
- surgical, chemical, or electrosurgical procedures[3]
- avoid chemical matrixectomy in uncontrolled diabetes mellitus. peripheral vascular disease & pregnancy (avoid phenol)[3]
- surgical, chemical, or electrosurgical procedures[3]
- 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]
More general terms
Additional terms
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/
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 Mayeaux EJ Jr, Carter C, Murphy TE. Ingrown Toenail Management. Am Fam Physician. 2019 Aug 1;100(3):158-164. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31361106 Free article. Review. https://www.aafp.org/pubs/afp/issues/2019/0801/p158.html