Ingrown Toenails Research Articles

Ingrown Toenail Device Therapy with a Cure Rate of 99.5%-Introduction of the Sogawa Method

Ingrown Toenail Device Therapy with a Cure Rate of 99.5%-Introduction of the Sogawa Method

Ingrown toenails treatment in diabetic patients: a Pilot Study of a new conservative treatment of orthonyxia.

Ingrown toenail (also onychocryptosis) is one of the most frequent nail pathologies in diabetic population. Neurological and vascular complications can increase painful symptoms and suffering of tissue which can lead to ulceration, therefore surgical matricectomy is not recommended. In this research we aim to evaluate the effectiveness of a 40% urea cream treatment associated whit nail acrylic resin brace (ortonixia) versus traditional cut and resin nail’s recostruction. Diameter of nail and NRS scale were used to evaluate change of nail plate and pain before and after treatment. 32 subjects with 52 treated nails were included. About 20 nails of 13 subject were recruited in experimental group. Differential final and initial diameter was 4.67±1,55 mm in experimental group and 3.01±1.26 mm in control group ( p<0.0001) and recurrence rate was 15% and 75% respectively ( p<0.0001). Also days of absence of pain, in experimental group there was a mean of 319.05±113.18 days, instead in control group there was a mean of 208.31±119.84 days (p<0.0002). This statistical analysis shows that effectiveness of new conservative approach is greater than in nail reconstruction method and a valid alternative to surgical treatment in diabetic patients.

Ingrown toenails treatment in diabetic patients: a Pilot Study of a new conservative treatment of orthonyxia.

Ingrown toenail (also onychocryptosis) is one of the most frequent nail pathologies in diabetic population. Neurological and vascular complications can increase painful symptoms and suffering of tissue which can lead to ulceration, therefore surgical matricectomy is not recommended. In this research we aim to evaluate the effectiveness of a 40% urea cream treatment associated whit nail acrylic resin brace (ortonixia) versus traditional cut and resin nail’s recostruction. Diameter of nail and NRS scale were used to evaluate change of nail plate and pain before and after treatment. 32 subjects with 52 treated nails were included. About 20 nails of 13 subject were recruited in experimental group. Differential final and initial diameter was 4.67±1,55 mm in experimental group and 3.01±1.26 mm in control group (p<0.0001) and recurrence rate was 15% and 75% respectively ( p<0.0001). Also days of absence of pain, in experimental group there was a mean of 319.05±113.18 days, instead in control group there was a mean of 208.31±119.84 days (p<0.0002). This statistical analysis shows that effectiveness of new conservative approach is greater than in nail reconstruction method and a valid alternative to surgical treatment in diabetic patients.

Step-by-step therapy that can treat ingrown toenail without pain-Experience of Sogawa method-

Step-by-step therapy that can treat ingrown toenail without pain-Experience of Sogawa method-

Radiofrequency-assisted lateral toenail onychotomy for ingrown toenail

Ingrown toenail or onychocryptosis is a common debilitating condition of the toenail affecting adolescents and young adults (Fig 1). It is associated with disabling pain, erythema, and purulent discharge. Excision of the lateral nail plate followed by chemical partial matricectomy has a high success rate in the treatment of onychocryptosis.1 The ingrown side of the nail plate is separated from the nail bed and proximal nail fold, cut straight using a nail nipper till under the proximal nail fold, and avulsed.

Translated article] Comparison of 2 Anesthetic Techniques in Onychocryptosis Surgery of the Great Toe: A Randomized Clinical Trial

Background and objectiveSurgery for an ingrown toenail of the great toe is a common procedure that requires an anesthetic neuromuscular blockade of the entire digit. Various digital block techniques have been described, but no evidence-based recommendations on the best choice have emerged. We aimed to compare the V block to the H block in this type of surgery. Material and methodsMulticenter randomized clinical trial in patients undergoing onychocryptosis surgery between February 2018 and February 2020. We recorded sex, age, foot intervened, type of blockade used (H block or V block), efficacy 10 and 20min after injection of the anesthetic, and number of attempts. ResultsA total of 140 surgeries to treat ingrown toenails were assigned to 2 groups (H block or V block) of 70 patients each. The same anesthetic, dose, and volume were used in all cases. The V technique produced a better neuromuscular block in 7.2% more cases at 10min and in 12.8% more at 20min. ConclusionsBoth block techniques are safe and effective. The V block is a good alternative to the H block in patients undergoing surgery to treat an ingrown toenail.

Therapeutic outcomes of one-minute application of sodium hydroxide versus phenol in the chemical cauterization of ingrown toenails.

Ingrown nails are frequently encountered in dermatology practice. The recurrence tendency of the disorder makes chemical cauterization essential during surgical procedures. In studies comparing nail matrix cauterization with sodium hydroxide (NaOH) versus phenol, phenol's application time was highly variable. To compare the therapeutic outcomes of matrix cauterization for a standard duration of one minute for NaOH versus phenol in stage II and III ingrown nails. The medical records of patients undergoing matrix cauterization with 10% NaOH or 88% phenol were evaluated. The primary outcome measure was the lack of recurrences on long-term follow-up. The secondary outcome measures were complete healing duration, patient-reported pain scores, and adverse effects related to the procedure. Enrolled in this study were 62 ingrown toenail sides treated with 10% NaOH and 56 ingrown toenail sides treated with 88% phenol. The mean follow-up duration was 25.17months. Recurrence was observed in four nail sides of the NaOH group (%6.45) and three nail sides of the phenol group (%5.35). The difference between the recurrence rates did not reach statistical significance. Patients treated with both methods were free of pain on the post-procedural tenth day. The visual analog scale pain scores and complete healing duration were similar between the two groups (p>0.05). In a large group with long-term follow-up results, the short-term and long-term post-operative treatment outcomes were similar between the one-minute applications of 10% NaOH versus 88% phenol groups.

Minor surgery in primary care has reduced minor surgery waiting lists: a 12-month review

BackgroundTo investigate minor procedures performed in general practice, to alleviate the burden on the economy, patients and secondary care physicians.AimsTo determine the range of minor surgical procedures performed in a single group general practice, subsequent referrals made to secondary care, follow-up surgical procedures required and post-operative complications within a patient group.MethodsRetrospective data collection from the electronic records of a single group general practice consisting of 5101 active patients within the previous 12 months. Through use of Socrates software program and statistical analysis, patients were stratified into demographics, including, age, gender, the cost of the procedure, the type of procedure being carried out, the post-operative referral rate to secondary care and any subsequent procedures required. The patients were excluded if their minor procedure was classified as a joint injection.Results133 procedures were carried out over the 12-month period. Of these patients, the majority were male, and the mean age was 44 years old. The most common procedures included the removal of ingrown toenails, lesion excisions and punch biopsies. Histological analysis was done on biopsies, with a low rate of misdiagnosis pre-operatively. Additionally, there were minimal referrals and no complications recorded.ConclusionsThis study has demonstrated the ability for minor surgery to be safely carried out in primary care. The integration of general practice, general surgery and plastic surgery could provide a higher level of patient care and exchange of skills to help reduce waiting lists and alleviate the burden secondary care.

Chronic Retronychia: Nonsurgical Treatment

Introduction: Retronychia is a particular form of post-traumatic ingrown nail associated with repeated microtrauma of the underside of the proximal nail fold. It is caused by the nail embedding backward into the underside of the proximal nail fold, forming multiple generations of nail plate. Methods: The study aims to evaluate the results of a novel nonsurgical treatment of retronychia. A review was performed on 20 patients who underwent the treatment, 16 having suffered from a chronic form of the condition, with the remaining 4 being afflicted with retronychia for less than a year prior to treatment. Results: The treatment was a combination of eliminating the proximal sharp edge of the uppermost nail layer and thinning of the nail with fraises and drills of various sizes. This therapy was repeated every 7–14 days. The patients came for checkup every 6 weeks. Treatment duration varied from 2 to 14 months. The rate, at which the appearance of a healthy nail occurred depended on the length of the intact nail layer below the part of the nail affected by retronychia, the age of the patient, and cofactors such as obesity, diabetes, etc. The treatment result in our case study was completely healthy nail growth without relapse of retronychia in all the 20 patients for a follow-up period of 18 months. Conclusion: By combining a healthy nail growth and the simultaneous protection of the nail, we were able to achieve a normal nail in all cases. In order to maintain the achieved results, we recommended our patients to continue wearing protective tubes whenever they would wear closed shoes because recurrence of retronychia may occur even after minimal trauma.

Efficacy and safety of phenol-based partial matricectomy in treatment of onychocryptosis: A systematic review and meta-analysis.

Chemical matricectomy is an established treatment modality of onychocryptosis. In this meta-analysis, we studied the efficacy and safety profile of phenol-based matricectomy. We performed an electronic database search of PubMed, EMBASE and grey literature using the search terms '(onychocryptosis OR ingrown toe nail) AND (phenol OR chemical matricectomy)' from inception till 31-12-2020, for controlled clinical trials with phenol in one of the treatment arms and at least 10 participants in each arm. From the initial search of 335, eighteen articles were included in the final analysis. There were a total of 1655 patients, of which 856 received phenol as an intervention modality. We found that nail matrix phenolisation was associated with a 49 fewer number of recurrences per thousand patients compared with other modalities (OR: 0.28-0.57, CI 95%). It also had a reduction in 175 cases of discharge or haemorrhage per thousand patients compared with other modalities (OR: 0.25, 95% CI: 0.14-0.45). However, we found that TCA- and NaOH-based matricectomies fared better compared with phenol in incidence of postoperative discharge and haemorrhage. Patients also experienced less pain (257 fewer number per 1000, OR: 0.52, 95% CI: 0.43-0.63). Nearly, half of the included studies had some concerns about the risk of bias. As of now, phenol matricectomy combines a low recurrence rate with favourable adverse effect profile and is the preferred modality for matricectomy in grade II and III onychocryptosis.

A Clinical Investigation to Evaluate the Safety and Performance of a Novel Self-Administered Treatment Kit for Ingrowing Toenail

Background: Ingrown toenail often results in a painful cycle of infection and inflammation and can affect the ability to go about everyday activities. In the UK and Europe, there are limited ways to prevent the development of ingrowing toenail without specialist intervention. Treatments are often invasive and may require periods of time off work. This prospective, single-site, non-comparative clinical study evaluates the performance, safety and convenience of a treatment kit that can be applied at home at the earliest signs of ingrowing toenail. Methods: Patients (n = 36) with mild ingrowing toenail used the Scholl Ingrowing Toenail Treatment kit for 6 weeks, with assessments by study investigators at Days 0, 21 and 42. The kit comprised a set of toenail clips and a spray, correct use of which was monitored at site visits and through patient diaries. Results: All patients enrolled in the study completed the 42-day treatment period. Severity of ingrowing toenail was significantly reduced in 88.9% (95% CI: 78.62, 99.15) of patients at the end of the study. Twenty-two patients (61.1%) exhibited full resolution of ingrowing toenail at Day 42 and none showed an increase in severity. Reduction in pain and severity of ingrowing toenail from baseline was significant at Days 21 and 42 (p < 0.0001). 63.9% of patients reported reduced discomfort and trauma using the treatment kit on the first day of treatment, which increased to 97.2% at the following visits. No serious adverse events or device events were reported. Most patients reported that the clips were convenient to use and did not impede their daily activities. Conclusions: The ingrowing toenail treatment kit was convenient and easy for patients to use at home and resulted in reduced pain and severity of ingrowing toenail at early stages of the condition.

Ingrown Toenail Treated by the Modified Howard-Dubois Technique: Long-Term Follow-Up Results.

According to the Mozena classification system, stage IIb and stage III ingrown toenail cases are considered as severe ones; however, limited options are available for treatment. To lower the recurrence rate and achieve primary intention healing in severe ingrown toenail cases by the modified Howard-Dubois technique. Forty patients were included in this study. In this procedure, a fish-mouth like soft tissue along the nail groove to the tip of the toe was resected, the upper surface of the distal phalanx was flattened and the nail bed matrix was remodelled. The European Quality of Life (EuroQol) questionnaire and Surgical Satisfaction Questionnaire were used to assess the outcomes. There were no recurrences observed during the follow-up period. Healing time from surgery to back to school or work was 10.82 days on an average (range: 7-23 days). According to the results of EuroQol questionnaire, improvements were achieved in the areas of mobility (50%), looking after myself (10%), doing usual activities (35%), having pain or discomfort (95%) and feeling worried, sad, or unhappy (55%). According to the results of Surgical Satisfaction Questionnaire, 38 (95%) patients indicated that they would undergo the surgery again if they 'had to do it all over again' and 36 (90%) patients said that they would recommend the procedure to others. This modified Howard-Dubois technique was an effective, safe and cosmetic alternation for the treatment of ingrown toenail in severe or relapsed cases.

A new modification of the Winograd technique for the treatment of ingrown toenail

A new modification of the Winograd technique for the treatment of ingrown toenail

A Case of Toe Necrosis after Treatment with Phenol Cauterization for Ingrown Toenail

A Case of Toe Necrosis after Treatment with Phenol Cauterization for Ingrown Toenail

Surgical Management of Retronychia.

Retronychia is an uncommon type of ingrown nail characterized by ingrowing of the proximal nail plate into the proximal nail fold (PNF), inciting cycles of inflammation. The condition can be symptomatic due to swelling and inflammation of the PNF, but most often it is noticed because of a proximal thickening of the nail plate and the failure of nail to grow distally. It usually affects the great toenails of young females, commonly due to recurrent trauma and footwear-related issues. This condition is difficult to recognize in the initial stages and often requires surgical management when the nail plate becomes significantly impacted. We present a case of retronychia in a 24-year-old lady, who was treated surgically. The report serves to highlight the diagnostic and therapeutic approach in such cases.

Comparación de 2 técnicas de bloqueo anestésico en el tratamiento quirúrgico de onicocriptosis del primer dedo del pie

Background and objectiveSurgery for an ingrown toenail of the great toe is a common procedure that requires an anesthetic neuromuscular blockade of the entire digit. Various digital block techniques have been described, but no evidence-based recommendations on the best choice have emerged. We aimed to compare the V block to the H block in this type of surgery. Material and methodsMulticenter randomized clinical trial in patients undergoing onychocryptosis surgery between February 2018 and February 2020. We recorded sex, age, foot intervened, type of blockade used (H block or V block), efficacy 10 and 20minutes after injection of the anesthetic, and number of attempts. ResultsA total of 140 surgeries to treat ingrown toenails were assigned to 2 groups (H block or V block) of 70 patients each. The same anesthetic, dose, and volume were used in all cases. The V technique produced a better neuromuscular block in 7.2% more cases at 10minutes and in 12.8% more at 20minutes. ConclusionsBoth block techniques are safe and effective. The V block is a good alternative to the H block in patients undergoing surgery to treat an ingrown toenail.

Efinaconazole in Onychomycosis.

Onychomycosis is a fungal nail infection that causes nail discoloration, nail plate thickening, and onycholysis. Efinaconazole 10% topical solution is an FDA-approved treatment for onychomycosis patients aged 6 years and above. The drug functions as an antifungal by disrupting ergosterol synthesis in the fungal cell membrane. It exhibits higher in vitro activity against dermatophytes than other available antifungals such as ciclopirox and itraconazole, and the activity is comparable to amorolfine and terbinafine. Efinaconazole also provides enhanced nail penetration compared with other topical antifungals due to low surface tension, poor water solubility, and low keratin affinity. The pharmacokinetic studies suggest that the efinaconazole topical delivery to the nail bed is not markedly affected by the presence of disease. There is a subset of onychomycosis patients who are more likely to respond to efinaconazole 10% solution: female patients, those with lower BMI, mild onychomycosis, a short disease duration, no infected non-target toenails (large toenail disease only), and when concomitant tinea pedis is treated. Experts recommend efinaconazole 10% topical solution as the first line for mild-to-moderate onychomycosis, pediatric onychomycosis, those with liver or kidney disease, and as maintenance therapy to prevent relapse. The side effects of topical efinaconazole are minimal: most commonly ingrown toenails, dermatitis, vesicles, and pain at the application site. Altogether, phase I and phase III clinical trials, and post-hoc analyses indicate that efinaconazole 10% topical solution is a safe and effective treatment for adult and pediatric onychomycosis, with a satisfactory mycological and clinical cure.

Cooperation Between a Doctor and a Podiatrist to Improve the Quality of Life of Patients with Ingrown Toenails

Abstract Cooperation between doctors of various specialties and other medical specialists is the standard of care in the treatment of patients. Due to the variety of diseases and the dynamic development of medicine in general, it is difficult to be an expert in every field and know all the recommended treatments. An example of such cooperation is the joint treatment of patients with the problem of ingrown toenails. The article contains an analysis of patients who received treatment in a doctor’s office in cooperation with podiatrists. A conservative approach towards the treatment of this condition sees the patient being initially diagnosed and treated by a podiatrist and then later, if necessary, being referred to a doctor for surgical treatment. The exchange of experiences and information on patients treated by interdisciplinary teams allows doctors and podiatrists to find the best possible treatment and improve the quality of life of patients. The follow-up of patients after surgery can be performed later in podiatry offices. Owing to modern electronic communication, it is possible for a doctor to constantly monitor the patient’s condition without the need for direct visits to the doctor’s office.

Common diseases of the nail: Diagnosis and therapy.

This review focuses on nail changes that do not belong to the group of benign or malignant nail tumors. These common afflictions of the nail include structural changes in and under the nail plate as well as inflammation around and in the nail bed. They include onychomycoses, nail psoriasis, onychodystrophies, subungual hematoma, paronychia, ingrown nails and pincer nails. Due to the peculiar anatomy and physiological growth conditions of the nail, the pathology does not necessarily stem from the site of the clinical problem and calls for careful inspection and interpretation.

Winograd surgery can be performed under partial digital block in patients with ingrown toenails

Winograd procedures performed under a partial digital block with a single needle to the surgical side instead of the entire toe were not evaluated. This study aimed to examine the clinical results of classic ring block and partial digital block performed during Winograd procedures in cases of ingrown toenails. A total of 210 patients underwent Winograd surgery were divided into two groups according to the type of anesthesia used as follows: traditional ring block (TRB) and partial digital block (PDB). Visual analog scale (VAS) scores, Heifetz stage patient satisfaction levels, recurrence rates, and need for reoperation were recorded. Compared with the PDB group, the during operation VAS score was statistically significantly higher in the TRB group (p=0001). There was no statistically significant difference between the groups in terms of postoperative satisfaction, recurrence (p=0294), and reoperation rates (p=0651). This study is the first to show that adequate anesthetic efficacy can be achieved with a less invasive intervention for Winograd procedures.