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