Ingrown Toe Nail

Onychocryptosis

 

Aetiology

 

Improper nail trimming

Tight shoes & socks

Poor hygiene

Repetitive trauma to distal toe

Curved nail bed in elderly

 

Stages

 

1.  Inflammation

- painful irritation about embedded nail plate in lateral groove

 

2.  Infection

- overt infection with granuloma & discharge 

- starts as serous discharge then purulent

 

3.  Granulation

- stage 1 & 2 + chronic changes

- hypertrophy of lateral wall

- growth of epithelium over chronic granulation tissue 

 

Management

 

Stage 1 

- non-operative

 

Stage 2 

- oral ABx then non-operative

- if fails partial nail avulsion

 

Stage 3 

- often requires partial nail matrix ablation

 

Non Operative

- warm saline soaks x2 /day

- pledget under nail corner

- cleaning of lateral groove

- nail will grow 2 mm /month

- aim for nail plate that protrudes distal to hyponychium

 

Operative

 

1.  Wedge resection

 

Technique

- remove lateral part of nail

- partial ablation of nail matrix

- debulk tissue in lateral fold

 

Post op

- non adherent dressings 48/24 then warm soaks

- open toe box shoe 10/7

- 3-4 weeks before normal shoes again

 

Complications

- recurrence spicules nail plate 

- 5%

 

2.  Zadek's

 

Technique

- removal of nail plate 

- removal of entire germinal nail matrix proximal to lunule

 

3.  Terminal Symes procedure

 

Technique

- amputation of the distal half of the distal phalanx

- good for dystrophic and mycotic nails

- toe end appears bulbous