Ingrown Nails

 

Ingrown nail conditions involve abnormalities associated with the anatomic components of the toenail and the surrounding soft tissue structure.

Onychocryptosis is the term used to describe an ingrown or "embedded" lateral nail border. Etiological factors include hereditary factors, improper trimming of toenails, ill-fitting shoes, subungual exostosis, soft tissue hypertrophy and repetitive micro trauma.

The clinical nature of onychocryptosis shows in inflammatory redness and swelling in Stage 1. Stage 2 reveals inflammatory secretion and Stage 3 exhibits granulation tissue. Paronychia is the common sequelae of onychocryptosis. As the nail border penetrates the soft tissue, bacterial invasion leads to soft tissue infection and a "foreign body" reaction. Prompt attention is necessary to resolve the infection and requires removal of the offending nail border, either as a temporary correction (partial nail avulsion) or permanently via partial chemical matricectomy. When appropriate, permanent correction should be performed initially as partial nail avulsion for symptomatic ingrowing toenails has a recurrence rate of anywhere from 60 to 85 percent.

Permanent treatment commonly calls for a partial chemical matricectomy of the involving nail border. This is performed via sterile technique under local anesthesia. Hemostasis is obtained via digital tourniquet, once adequate digital circulation is assessed. Adequate width is determined and the nail is split distal to proximal, completely under the eponychium. The nail border is removed from the nail bed and nail root. A chemical application is utilized in a timely fashion to bathe the exposed area, neutralizing nail producing tissue. Antibiotic dressings and mild soaks are often used in the post-op period.

THE PARTIAL CHEMICAL MATRICECTOMY IS AN EXCELLENT PROCEDURE TO RESOLVE THE PAINFUL INGROWN TOE NAIL.

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