Ingrown Toenails Research Articles

Nail changes in children with idiopathic congenital clubfoot deformity.

Nail alterations are commonly seen in cases of idiopathic clubfoot and may cause parental concern. The nature of and whether these changes are congenital or develop secondary to treatment has been poorly investigated. The aim of this study was to evaluate toenail morphology in clubfoot patients at presentation, to re-evaluate them during the course of treatment for the clubfoot, and to analyze findings in the light of the few literature reports for healthy children of the same age. Thirty infants (21 males and 9 females) with idiopathic clubfoot were prospectively enrolled at the Anna Meyer Children's University Hospital. Nails of affected and non-affected feet were evaluated by a team of pediatric dermatologists at presentation and re-evaluated once per patient during the bracing period of Ponseti treatment. Toenails of affected (47) and non-affected (13) feet were abnormal at presentation in 43.3% of patients, in both clubfeet (40.4%) and non-affected feet (38.5%), but most changes were physiologic or transitory alterations, commonly found in healthy children, with nail concavity (koilonychia) being the most common finding (29.7%). Changes were not related to clubfoot severity or laterality (P>.05). In most (76.9%) unilateral cases, there was concordance of nail changes between clubfoot and non-affected foot. At re-evaluation (follow-up time 410±207days), nail problems were more frequent (53.3%); ingrown toenail was the most common (21.6%). The presence of nail alterations seems not to be caused by clubfoot pathology and could be related to unfavorable local condition in the brace.

Aggressive Recurrence of ingrown Toenail in Pediatric Patient

Carlos Leganés Villanueva1*, Nuria Brun Lozano1, Federica Bianchi1, Ilaria Goruppi1 and Susana Boronat Guerrero2 Author Affiliations 1Pediatric Surgery Unit. Department of Pediatrics. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain 2Department of Pediatrics. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain Received: March 29, 2021| Published: April 09, 2021 Corresponding author: Carlos Leganés Villanueva, Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain, E-mail: cleganes@santpau.cat DOI: 10.26717/BJSTR.2021.35.005643

Focus on the onychocryptosis

Focus on the onychocryptosis

The effectiveness of nail excision versus Vandenbos procedure for the surgical management of ingrown toenails in children: A retrospective chart review

BackgroundIngrown toenail commonly occurs in patients who have experienced trauma or long-term compression to their toes. There exist two common methods of surgical management – wedge resection and Vandenbos procedure. We compared the recurrence rate of these two methods in pediatric patients. MethodsWe conducted a retrospective study reviewing patients who presented to our institution with ingrown toenail between 2009 and 2015. Patients who received any surgical treatment outside of our institution or were over 18 years of age were excluded. ResultsThere were 523 patients seen at our institution with ingrown toenail. Of these patients, 482 had sufficient data available to be included in this study, with a total of 929 ingrown toenails. Out of these, 333 were managed conservatively while the remaining 596 required surgical intervention; 373 had wedge resection performed and the other 223 had Vandenbos procedure. Our analysis determined that 78 total complications arose in the wedge resection group (21%) while 32 total complications arose in the Vandenbos group (14%; p = 0.0949). Wedge resections had a significantly higher recurrence rate than Vandenbos procedures (41 (11%) vs 5 (2%), p = 0.0001). ConclusionSurgical complications are comparable between wedge resections and Vandenbos procedure. Vandenbos procedure offers a significantly lower recurrence rate than wedge resection. Level of evidenceLevel III.

The association between foot alignment and the development of ingrown toenails: A case-control study in a young adult military population

BackgroundThis case-control study aimed to explore an association between foot alignment and development and presentation of the ingrown toenail. MethodsRadiographs were evaluated for hallux interphalangeal angle (HIA), hallux valgus angle (HVA), talonavicular coverage angle (TNC), talo-first metatarsal (Meary’s) angle, and calcaneal pitch angle (CP), as well as medial sesamoid position in a cohort of 103 young and healthy patients (mean age of 20.5 years) with ingrown toenails. A control group of 63 patients was included, and the radiographic parameters were compared. Subgroup analysis was performed in patients with lateral (n = 65) or medial (n = 38) nail fold involvement. ResultsThe overall study group demonstrated a larger TNC and Meary’s angle and smaller CP than the control group, while no significant difference was found regarding the HIA and HVA. The lateral nail fold group had a larger HIA when compared to the medial nail fold group. Multiple regression analysis revealed that for ingrown toenail development, the only risk factor was a decrease in the CP. In the case of lateral nail fold involvement, an increase in the HIA found to be the only factor. ConclusionA lower medial longitudinal arch seems to be a predisposing factor in developing an ingrown toenail. The lateral nail fold involvement was associated with lateral deviation of the distal phalanx. The result of this study could provide information on prevention, treatment, recurrence, and patient counseling of an ingrown toenail in otherwise young and healthy individuals.

Toe nail changes in diabetes mellitus

Introduction: Diabetes is a metabolic disorder caused by abnormal release of or sensitivity to the insulin hormone, with loss of blood glucose control. Un controlled diabetes can have devastating effects on many organ systems including cardiovascular, neurologic, ocular, and renal, with its impact on skin, hair, and nail. diabetes mellitus is a predisposing factor for onychomycosis (OM),paronychia and ingrowing toe nail defects. In the present study evaluation of the prevalence and types of nail changes was done. Materials and Methods: During a 1 year study period (June 2018 to May 2019), patients with diabetes mellitus were screened for toenail changes. Demographic, social, and clinical data were recorded. Informed written consent was taken. Fungal infection was confirmed by nail clippings microscopy. Results: Of the 60 patients most common nail changes are subungual hyperkeratosis, onycholysis, and onychomycosis, and less common changes are Twenty nail dystrophy, Dorsal pterygium, Terry’s nail in liver disease and diabetes mellitus and Subungual wart. Conclusions: Physicians who care for diabetic patients should not ignore nail changes. Careful global evaluation of patients with diabetes should include observation of nail changes. Keywords: Nails, Diabetes mellitus.

Suture-secured modified gutter splint method for the conservative treatment of ingrown toenails

Suture-secured modified gutter splint method for the conservative treatment of ingrown toenails

Spiculectomy and Orthonyxia for Ingrown Toenails in Patients at Risk; Prospective Observational Cohort Study

Background: Ingrown toenails (unguis incarnatus) are common in persons with Diabetes Mellitus (DM) and Peripheral Arterial Disease (PAD). Minimal invasive treatment of ingrown toenails with spiculectomy and/or orthonyxia might be a promising treatment option. Aim: The aim of this study was to evaluate the efficacy and safety of minimal invasive treatment spiculectomy and orthonyxia Design/Setting: Prospective observational cohort study in an outpatient podiatric clinic Method: Eighty-eight patients with unguis incarnatus were included. Primary outcomes were post-procedural complication rate (infection and hemorrhage), and duration of pain. Patient satisfaction during and after treatment procedure was evaluated. Results: Healing was achieved in 80/88 (90.9%) persons; non-DM group 28/32 (87.5%) vs DM group 51/56 (91.1%); median healing time (21 [14, 42] days) and median treatment time; (56 [30, 86] days) were comparable between the non-DM and the DM groups. (Sixty-four patients (72.7%) had a significant pain reduction within 0-2 days. Median reduction of the VAS score after the first treatment was 2.0 points [0.0, 6.0] (non-DM group 3.5[1.0, 6.0]; DM group 2.0[0.0, 5.0] (p=0.0117)). Forty-eight (94, 4%) patients, 31(96.9%) non-DM group vs 53(94.6%) DM group (p=0.534)) had no limitations in daily activities by the affected toe after 14 days. There were no treatment-related complications like bleeding or infection. Conclusion: Spiculectomy and orthonyxia resulted in a high patient satisfaction. Five of 88 patients needed referral for a partial nail resection. This treatment seems to be very suiTable for persons with a high risk for foot ulcerations.

A fast and effective solution for ingrown toenail: Creation of a 2-mm space between tissue and nail by sutureless lateral longitudinal excision

Nails have both functional and aesthetic importance. Undertreatments cause frequent recurrences affecting its functionality, while over-treatment spoils the aesthetic view. To describe the most practical and aesthetic method to treat ingrown toenail. All patients with ingrown toenail who applied to outpatient clinics of General Surgery Department between 2013 and 2019 were enrolled. A 2-mm space between tissue and nail by lateral longitudinal excision was created with only minimal matricectomy, under local anaesthesia. A total of 2334 surgical procedures were performed in 2118 patients. Recurrence rate was 1.7% during 36-month follow-up, most (70.7%) in younger men (22 years). The location of the lesions (right/left, medial/lateral or bilateral) did not show difference (p > 0.05 for each). Predisposing factors were tight-fitting footwear (4.5%), incorrect nail-trimming (3%), genetic tendency (2.8%), obesity (2.1%) and trauma (0.75%); but each was p > 0.05. Mean operation time was 3 min. There was no important complication, except hematoma (0.89%) and infection (0.68%). Mean healing time was 10 days and patients returned to daily activities in 3 days. Longitudinal excision with minimal matricectomy technique provides all dead tissue and diseased parts of nail and soft tissue to be removed. It is simple, cost-effective, satisfactory and aesthetic. SBU/23.01.2019/B.10.1.TKH.4.34.H.GP.0.01/7 (retrospectively registered).

A Minimally-Invasive, Simple, Rapid, and Effective Surgical Technique for the Treatment of Ingrown Toenails: A Reminder of the Original Winograd Procedure.

(1) Background: Ingrown toenail is a common disorder of the toe that induces severe toe pain and limits daily activities. The Winograd method, the most widely used operative modality for ingrown toenails, has been modified over years to include wedge resection of the nail fold and complete ablation of the germinal matrix. We evaluated the outcomes of original Winograd procedure without wedge resection with electrocautery-aided matrixectomy. (2) Methods: We retrospectively analyzed the outcomes of patients who underwent surgery for ingrown toenails at a university hospital for two years from November 2015 to October 2017. Surgery was performed in 76 feet with a mean operation time of 9.34 min. (3) Results: The minimal interval from surgery to return to regular activities was 13.26 (range 7 to 22) days. Recurrence and postoperative wound infections were found in 3 (3.95%) and 2 (2.63%) patients, respectively. Evaluation of patient satisfaction at one-year follow-up showed that 40 (52.63%) patients were very satisfied, 33 (43.42%) were satisfied, 3 (3.95%) were dissatisfied, and none of them were very dissatisfied. The average follow-up duration was 14.66 (range 12 to 25) months. (4) Conclusions: Therefore, it is believed that this less-invasive and simple procedure could be easily performed by clinicians, with satisfactory patient outcomes.

A Case of an <i>Ex Vivo</i> Onychomycosis Model Introduced with a Cultured Colony of <i>Kocuria koreensis</i> from a Diabetic Ingrown Toenail

A 57-year-old male patient with >10-year history of type 2 diabetes presented with a left big toenail deformity and pain. A physical examination revealed a white and yellow-to-brown patch on the nail as well as thickening and ingrowth of the nail plate. The nail plate was opened using nippers, and a fungal culture revealed Trichophyton interdigitale with yellow yeast. The yeast isolate was identified as Kocuria koreensis, a Gram-positive aerobic coccoid with keratinolytic properties that is part of the normal flora of the skin. We created an ex vivo onychomycosis model of T. interdigitale infection of the human nail by placing a sterilized normal nail on the cultured slant. K. koreensis initially spread over the normal nail, and T. interdigitale then penetrated the nail plate. After one year and six months, a spiral ingrown nail developed. A histopathological examination of the spiral revealed onychomycosis with superficial and deep abscesses of Gram-positive cocci infection. We performed PCR from paraffin-embedded material, and the sequences obtained were identical to those of T. interdigitale and K. koreensis. These results suggest that the development of onychomycosis by T. interdigitale is introduced and accelerated by K. koreensis, and the symbiosis of these microorganisms is suspected in the nail. This ex vivo model has a number of limitations. Therefore, further research on co-infected cases is needed to confirm this hypothesis.

Six steps to standardize the surgical approach for ingrown toenail

BackgroundDermatologists don’t have a good knowledge of the surgical treatment for ingrown toenails and there is no consensus on which is the best approach. ObjectiveTo develop an easy and effective surgical approach to solve the problem of ingrown toenails. MethodsWe identified 67 patients with ingrown toenails in varying degrees of severity which were treated with the standardized approach. ResultsAll the patients had a completely recovery from the disease and none complained about the cosmetic result. Study limitationsThe number of cases is limited. ConclusionThe standardized surgical approach is easily learned and very effective. The recurrence rate is lower than with other treatments.

Immediate Nail Bed Graft on Exposed Distal Phalanx in Fingertip Injury

Fingertip injuries with nail bed defects have traditionally been covered with full- or split-thickness nail bed grafts. However, it was widely understood, without sufficient evidence, that graft take is difficult if the nail bed is grafted directly on the distal phalanx. This study reports two successful cases of nail bed graft on sterile matrix defects with exposed bare cortical bone. Two patients suffered a crush injury on their fingers. While there was no fracture, the distal phalanx was exposed with a nailbed defect. As the defect was too large for primary closure and too small for flap coverage, a sterile matrix nailbed graft was performed using the ipsilateral big toe. In both cases, damaged nails have grown fully, identical to the contralateral finger with smooth and flat regrowth of the nail and adherence of the growing nail. Both outcomes were graded as excellent according to Zook’s criteria. No major complication was found except for a minor ingrown nail on donor site in both cases. Even if there is a nail bed defect with exposure of cortical bone, successful nail reconstruction could be obtained through immediate nailbed graft on the exposed distal phalanx.

Unguis incarnatus-conservative or operative treatment? Apractical treatment algorithm

Der Unguis incarnatus ist ein häufiges Krankheitsbild, mit dem sich Patienten in der Hausarztpraxis, der dermatologischen Klinik oder der chirurgischen Notaufnahme vorstellen. Häufig führt die inkonsequente konservative Therapie oder die falsch-indizierte operative Intervention zu langwierigen und komplikationsreichen Verläufen, inklusive Rezidiven. Die Patienten sollten über die Komplexität des Nagelorgans aufgeklärt werden, um der Banalisierung der Erkrankung vorzubeugen, und eine entsprechende Compliance in der Therapie zu erreichen. In diesem Manuskript wird die sachgerechte Versorgung des Unguis incarnatus im Sinne eines praktischen Behandlungsalgorithmus dargestellt. Die konsequente konservative Therapie ist bei akutem Unguis incarnatus mit milder Ausprägung die Therapie der ersten Wahl mit guten Behandlungsergebnissen. Nagelerhaltende operative Eingriffe kommen bei moderaten/schweren akuten Formen zum Einsatz. Der chronische Unguis incarnatus, ohne floride Infektion, stellt eine elektive Operationsindikation dar. Sowohl bei den nagelerhaltenden Eingriffen als auch bei erweiterten operativen Maßnahmen ist eine chirurgische Operationsaufklärung obligat.

Polyethylene Nail Brace for Ingrown Toenails Treatment: A Randomized Clinical Trial.

Background: Onychocryptosis is one of the most prevailing onychopathies and one of the usual reasons for visiting podiatry clinics. In this research, we aim to evaluate the effectiveness of a procedure of nail reeducation technique via a strip of polyethylene in subjects with stage I or IIa onychocryptosis, in which pathological toenail curves are present. Methods: This research was a randomized clinical trial (ACTRN12615000834550). The sample was made up of 94 cases of stage I or IIa onychocryptosis, according to the Mozena classification. Briefly, 46 cases were treated with the combination of a spicule technique and nail brace with a polyethylene plastic strip, and 48 were only treated with the spicule technique. Results: The combination of the spicule technique and the nail brace technique with a strip of polyethylene had a significantly lower recurrence rate compared to that achieved with just the spicule technique, twelve months after the beginning of the study (N.S. = 0.000 for α = 0.05). The change in the nail width achieved with the nail brace technique, twelve months after the beginning of the study, was statistically significant (N.S. = 0.000 for α = 0.05). Conclusions: The recurrence rate of the spicule technique alone was significantly higher than the combined technique of spicule with nail brace. A nail brace with a strip of polyethylene reduces the recurrence rate of onychocryptosis.

Electrocautery with partial matrixectomy in comparison with partial matrixectomy alone in treatment of ingrown toenail

Background Ingrown toenail is a frequent health problem that is commonly seen in adults and young individuals and subsequently results in significant socioeconomic outcomes. The inflammation of toenail tissue is the most prevalent manifestation. Despite the existence of different therapeutic modalities, there is no consensus on the optimal management yet. Objective The aim was to assess the effectiveness of electrocautery after partial matrixectomy with partial matrixectomy alone in the management of ingrown toenails. Patients and methods The population of ingrown toenail cases was divided into two categories, with 100 patients in each one, who had partial matrixectomy at outpatient clinic of general surgery at Mansoura University Hospitals from October 2015 to October 2018. The recruited patients of the study had follow-up observation for 180 days at an outpatient department. Results All eligible patients were operated and got high rate of surgical success; however, 13 cases of recurrence were noticed within the follow-up observation, including eight cases in the group of partial matrixectomy alone and five ones in the other group. Conclusion A great difference in the surgical outcome was noticed between these two groups, indicating that matrix electrocautery is connected with less recurrence rate vs the partial matrixectomy alone, with shortened healing time for both.

Onychocryptosis complicated with osteomyelitis – A case report from tertiary wound care center in South India

Onychocryptosis or in-grown nail is a painful condition caused by the nail plate’s penetration into the soft surrounding tissue. If left untreated, it leads to infection, discharge, and difficulty in walking, seriously impeding the quality of life of the person. We present a case study of 26-year-old male non-diabetic, in-grown toenail involving the right great toe with osteomyelitis and lymphedema in the right leg. Onychectomy was performed to the patient’s right great toe followed by bone curettage to remove the infected bone. The patient was prescribed with analgesics and antibiotics and he was under constant medical follow- up once a week to change the dressing. Consecutive and careful administration revealed that the growth of healthy matrix and lymphedema is significantly under control.

A case of ingrown toenail with maggots: A personal experience

The invasion of the skin and sub-cutaneous tissues with larvae (Maggots) is not infrequently seen in humans. It is basically the flies which feed on living tissues and lay eggs which develop into maggots and start eating the dead tissue. We present a very unusual case of a 35-year-old, mentally retarded man who presented with infected ingrown toenail. The patient had inborn deformity and crowding of the toes. On examination a large number of maggots were found crawling over and coming out from deeper tissues. The wound was explored and treated by excising the tissue alongside the nails with nail removal at the same time. The nail plate excised on the sides and maggots cleared.

Foot care knowledge and practices among Japanese nurses and care workers in home care and adult service center: a cross- sectional study

BackgroundFoot care knowledge and practices among nurses and care workers in the community greatly impact foot health maintenance and prevention of foot-related problems among older people. This study aimed to explore and examine the current foot care knowledge, practices, and perceptions among nurses and care workers at home care and adult day service center, along with their demographic characteristics and daily care for clients.MethodsThis study analyzed 232 randomly selected front-line nurses and care workers working at home care or adult day service center in one of the selected cities, Aichi Prefecture, Japan. Data were obtained using questionnaires and subsequently analyzed using descriptive statistics, t-tests, Chi-square tests, Wilcoxon rank-sum tests, and Spearman’s rank correlation tests.ResultsAmong the 305 surveyed, 232 (62 nurses; 170 care workers) provided data. Although 57 nurses (91.9%) and 142 care workers (83.5%) showed interest in foot care, 33 nurses (53.2%) and 133 care workers (78.2%) stated that foot care education was insufficient. Knowledge and practice scores were associated with working status.Higher accuracy differences in the early detection of foot problems and skin tears on lower limbs in knowledge category were observed between nurses and care workers. The nurses as well as the care workers had low accuracy rates of knowledge questions regarding the use of shoes and socks subscale.For practice, both nurses and care workers had low mean scores for checking client’s shoes (2.0/5.0 and 2.1/5.0, respectively), method for reducing ingrown nail pain (2.6/5.0 and 1.9/5.0, respectively), and opportunity for discussing foot care with others (2.7/5.0 and 2.2/5.0, respectively). A significant correlation between knowledge and practice scores was observed among nurses (0.331, p < 0.05) and care workers (0.339, p < 0.001).ConclusionsDespite the presence of several barriers toward enhanced care delivery to clients needing it most, nurses and care workers clearly understood the importance of foot care. These findings indicate that foot care should be focused by nurses and care workers to improve the knowledge and practice of foot care and to suggest future implications that efficient and understandable tools are needed considering their current working situation.

Oral Bisphosphonate use Reduces Cardiovascular Events in a Cohort of Danish Patients Referred for Bone Mineral Density.

The cardiovascular (CV) safety of oral bisphosphonates (oBPs) is uncertain. Determine the risk of CV events in oBP users referred for bone mineral density (BMD) testing compared with matched controls. Cohort study. Danish national prescription registry enriched with local hospital data from Odense. Individuals aged ≥45 years referred for BMD testing. oBP. Hospitalization for any CV event. Secondary study outcomes were specific CV events. Negative (inguinal hernia surgery and ingrown toenail) and positive (fragility fracture) control outcomes assessed systemic bias. Cox proportional hazards models were fitted to estimate hazard ratio (HR) and 95% confidence intervals. There were 2565 oBP users (82.6% women) and 4568 (82.3% women) propensity score-matched controls. Alendronate accounted for 96% of oBP prescription. A total of 406 (15.8%) CV events occurred in oBP users (rate = 73.48 [66.67-80.98]); rate = events divided by person-time; and 837 (18.3%) events in controls (rate = 104.73 [97.87-112.07]) with an adjusted HR of 0.68 (95% CI 0.60-0.77). Additional adjustment for BMD did not attenuate estimates (HR 0.67; 95% CI 0.58-0.78]. Similar results were seen for secondary outcomes where risk reductions were seen regarding atrial fibrillation, stroke, heart failure, and aneurysms. Positive and negative control outcome analyses identified minimal residual confounding. Oral BP users experienced a 33% reduced risk of CV events. This observational real-world study adds to a growing body of evidence for cardioprotection by oBP that warrants testing in a randomized setting.