Table 1 - uploaded by Eckart Haneke
Content may be subject to copyright.
Source publication
Ingrown toenails are one of the most frequent nail disorders of young persons. They may negatively influence daily activities, cause discomfort and pain. Since more than 1000 years, many different treatments have been proposed. Today, conservative and surgical methods are available, which, when carried out with expertise, are able to cure the disea...
Context in source publication
Citations
... Malposition of the nail, be it due to malalignment of the nail itself, displacement of the distal phalanx, or hallux valgus, results in chronic repeated microtrauma to the nail, resulting in subungual hyperkeratosis, onycholysis, paronychia, Beau's lines, onychomadesis, and onychomycosis [57,61,62]. Onycholysis, too short a nail, or lack of the nail of the big toe after nail avulsion or traumatic nail loss, leads to a distal bulge and a shortened or disappeared nail bed [63,64]. The bulge is part of the toe tip and covered with ridged skin; there is no epidermization of the nail bed, as is easily seen by the sharp delimitation between the bulge and the shortened nail bed [65]. ...
Introduction: It has long been accepted that trauma is one of the most important and frequent predisposing factors for onychomycoses. However, the role of direct trauma in the pathogenesis of fungal nail infections has only recently been elucidated in a series of 32 cases of post-traumatic single-digit onychomycosis. The importance of repeated trauma due to foot and toe abnormalities was rarely investigated. Aimof the study: This is a multicenter single-author observational study over a period of 6 years performed at specialized nail clinics in three countries. All patient photographs taken by the author during this period were screened for toenail alterations, and all toe onychomycosis cases were checked for whether they contained enough information to evaluate potential foot and toe abnormalities. Particular attention was paid to the presence of hallux valgus, hallux valgus interphalangeus, hallux erectus, inward rotation of the big toe, and outward rotation of the little toe, as well as splay foot. Only cases with unequivocal proof of fungal nail infection by either histopathology, mycologic culture, or polymerase chain reaction (PCR) were accepted. Results: Of 1653 cases, 185 were onychomycoses, proven by mycologic culture, PCR, or histopathology. Of these, 179 involved at least one big toenail, and 6 affected one or more lesser toenails. Three patients consulted us for another toenail disease, and onychomycosis was diagnosed as a second disease. Eight patients had a pronounced tinea pedum. Relatively few patients had a normal big toe position (n = 9). Most of the cases had a mild to marked hallux valgus (HV) (105) and a hallux valgus interphalangeus (HVI) (143), while hallux erectus was observed in 43 patients, and the combination of HV and HVI was observed 83 times. Discussion: The very high percentage of foot and toe deformations was surprising. It may be hypothesized that this is not only a pathogenetically important factor but may also play an important role in the localization of the fungal infection, as no marked hallux deviation was noted in onychomycoses that affected the lesser toes only. As the management of onychomycoses is a complex procedure involving the exact diagnosis with a determination of the pathogenic fungus, the nail growth rate, the type of onychomycosis, its duration, and predisposing factors, anomalies of the toe position may be important. Among the most commonly mentioned predisposing factors are peripheral circulatory insufficiency, venous stasis, peripheral neuropathy, immune deficiency, and iatrogenic immunosuppression, whereas foot problems are not given enough attention. Unfortunately, many of these predisposing and aggravating factors are difficult to treat or correct. Generally, when explaining the treatment of onychomycoses to patients, the importance of these orthopedic alterations is not or only insufficiently discussed. In view of the problems encountered with the treatment of toenail mycoses, this attitude should be changed in order to make the patient understand why there is such a low cure rate despite excellent minimal inhibitory drug concentrations in the laboratory.
... However, the most significant factor in treatment choice stems from the available specialty. Podologists and pedicurists favor conservative management procedures using braces and similar devices, while some dermatologists use other noninvasive approaches, and the majority tend to perform surgery [12]. ...
Background: The management of ingrown toenails in Nigeria is notably underdeveloped, posing potential challenges for patients in mental health facilities and beyond. Addressing this issue requires an interdisciplinary approach and collaboration with other healthcare professionals. Furthermore, there is an important need for a comprehensive review of the treatment guidelines for the anesthetic and surgical techniques utilized in its treatment to improve the quality of patient care. Methods: We employed a structured narrative approach to identify and review available articles on ingrown toenail management in mental health and other health facilities in Nigeria. We aimed to evaluate the anesthetic and surgical techniques utilized in managing these patients. Results: No documented treatment for ingrown toenails was identified among patients in mental health facilities across Nigeria. While various surgical techniques are employed for management in other health facilities, the specific anesthesia techniques utilized are unclear. Conclusions: A unified management protocol and guideline for ingrown toenails and developing podiatry training in Nigeria are imperative. Developing and implementing an effective treatment protocol improves the quality of care and widens coverage for all patients. In addition, establishing podiatry training across educational facilities could bridge this gap in ensuring optimal care for these patient populations.
... Malposition of the nail be it due to malalignment of the nail itself, displacement of the distal phalanx or hallux valgus, results in chronic repeated microtrauma to the nail resulting in subungual hyperkeratosis, onycholysis, paronychia, Beau's lines, onychomadesis, and onychomycosis [58,62,63]. Onycholysis, too short a nail or lack of the nail of the big toe after nail avulsion or traumatic nail loss lead to a distal bulge and a shortened or disappeared nail bed [64,65]. The bulge is part of the toe tip and covered with ridged skin; there is no epidermization of the nail bed as is easily seen by the sharp delimitation between the bulge and the shortened nail bed [66]. ...
Introduction: It has long been accepted that trauma is one of the most important and frequent predisposing factors for onychomycoses . However, the role of direct trauma in the pathogenesis of fungal nail infections was only recently been elucidated in a series of 32 cases of post-traumatic single-digit onychomycosis. The importance of repeated trauma due to foot and toe abnormalities was rarely investigated.Aim of the study: This is a multicenter single-author observational study over a period of 6 years performed at a specialized nail clinic in three countries. All patient photographs taken by the author during this period were screened for toenail alterations and all toe onychomycosis cases were checked whether they contained enough information to evaluate potential foot and toe abnormalities. Particular attention was paid to the presence of hallux valgus, hallux valgus interphalangeus, hallux erectus, inward rotation of the big toe and outward rotation of the little toe, as well as splay foot. Only cases with unequivocal proof of fungal nail infection by either histopathology, mycologic culture or polymerase chain reaction (PCR) were accepted.Results: Of 1653 cases, 185 were onychomycoses proven by mycologic culture, PCR or histopathology. Of these, 179 involved at least one big toenail, 6 affected one or more lesser toenails. Three patients consulted us for another toenail disease and the onychomycosis was diagnosed as a second disease. Eight patients had a pronounced tinea pedum. Relatively few patients had a normal big toe position (n = 9). Most of the cases had a mild to marked hallux valgus (HV) (105) and a hallux valgus interphalangeus (HVI) (143), hallux erectus was observed in 43 patients, the combination of HV and HVI was observed 83 times. Discussion: The very high percentage of foot and toe deformations was surprising. It may be hypothesized that this is not only a pathogenetically important factor but may also play an important role for the localization of the fungal infection as no marked hallux deviation was noted in onychomycoses that affected the lesser toes only. As the management of onychomycoses is a complex procedure involving the exact diagnosis with determination of the pathogenic fungus, the nail growth rate, the type of onychomycosis, its duration and predisposing factors, anomalies of the toe position may be important. Among the most commonly mentioned predisposing factors are peripheral circulatory insufficiency, venous stasis, peripheral neuropathy, immune deficiency and iatrogenic immunosuppression whereas foot problems are not given enough attention. Unfortunately, many of these predisposing and aggravating factors are difficult to treat or to correct. Generally, when explaining the treatment of onychomycoses to the patients, the importance of these orthopedic alterations is not or only insufficiently discussed. In view of the problems encountered with the treatment of toenail mycoses, this attitude should be changed in order to make the patient understand why there is such a low cure rate despite excellent minimal inhibitory drug concentrations in the laboratory.
... An ingrown nail is defined as the periungual skin perforation by the opposite nail plate [2]. Most commonly, stinging initiates at the distal end of one or both lateral nail grooves [3]. Ingrown nails commonly occur in adolescents and young adults; however, their incidence is higher in men [1,4]. ...
Introduction
Ingrown nail is a condition caused by the perforation of the periungual soft tissues on nail folds by the sides of nail plaque, causing inflammation and severe pain. Recently, the role of foot anatomical disorders in ingrown nail development has been emphasized.
Objectives
The main objective of this study aimed to determine whether foot deformities played significant roles in ingrown nail development with objective radiological parameters.
Methods
The study included 64 patients diagnosed with clinical ingrown nail and 71 patients as controls without any ingrown nail history. In both groups, we evaluated the bilateral foot radiographs of patients with ingrown nails for hallux valgus angle (HVA), interphalangeal angle (IPA), and intermetatarsal angle (IMA) associated with hallux valgus, and the calcaneal pitch angle (CPA), talohorizontal angle (THA), and talometatarsal angle (TMA) related to pes planus.
Results
No significant difference was found in terms of hallux valgus radiological measurements of HVA, IPA and IMA as well as pes planus radiological measurements of CPA and TMA values, when compared to controls. THA was statistically significantly higher in the control group (P = 0.025). There was a moderate strength positive relationship between ingrown nail stage and measured TMA for pes planus diagnosis (rho = 0.326; P = 0.04), yet there are no significant correlations between ingrown nail stage and other angles.
Conclusions
Therefore, we do not recommend foot anatomy correction in the prevention and treatment of ingrown nails, unless there is an accompanying foot deformity; however, pes planus is a foot deformity that can accompany patients with severely ingrown nails.
... This is a method that, when applied chronically and appropriately, allows for satisfactory results in cases of mild-stage disease. Most patients can apply it themselves at home after proper training [16]. The aim of this method is to lift the skin fold away from the nail plate using flexible tape. ...
... The aim of surgical intervention is to correct the improper interaction between the nail plate and the nail fold [16]. Surgical intervention for ingrown toenails is recommended when conservative treatments prove ineffective or when the condition becomes highly painful or recurrent, and the patient expresses a desire for a more definitive solution [28]. ...
... For 208 various modifications of this method described in the literature, the recurrence rate ranged from 10.2% to 17.7% [39,40,41]. The healing process of the postoperative wound can extend up to 6 weeks and is associated with an increased risk of infection [16]. ...
Ingrown toenails, clinically known as onychocryptosis, represent a prevalent nail pathology. The clinical manifestation involves symptoms typical for a foreign body reaction and in severe cases, tissue hypertrophy with complications may occur. Key risk factors include improper nail care, trauma, obesity, tight footwear, poor foot hygiene, and genetic predisposition. The condition predominantly affects individuals between the first and the third decades of life and older adults, with a predilection for the great toe, especially the lateral skin fold. The Heifetz and Scholz classifications delineate the stages of ingrown toenails based on severity. Therapeutic approaches range from conservative procedures, such as taping, dental floss, gutter treatment, cotton nail cast, braces and super elastic wire to surgical interventions like partial or total nail avulsion, matricectomy and advanced techniques like the Vandebos procedure or the Winograd procedure. Although many studies have analysed available treatment methods, there is no consensus among specialists regarding the best therapeutic strategy. Complications include paronychia, infection, and scarring. A comprehensive therapeutic approach should consider clinical severity, patient preferences, and both conservative and surgical interventions, emphasizing the importance of larger randomized clinical trials to establish definitive guidelines.
... The condition occurs when the nail plate pierces the sulcus, giving rise to pain, inflammation and infection 1 . The skin's attempt at healing leads to the formation of hypergranulation tissue (HGT) -vascularized oedematous stroma containing a mixed infiltrate of inflammatory cells 2 , which continues to be produced until the nail is removed 3 . Multiple staging systems for IGTNs exist, but most describe a variation of the original classification put forward by Heifetz 4 Nail surgery techniques for permanent removal of part or all of a nail fall into two categories, the latter with the use of phenol being the most popular 5 : ...
... Some authors suggest that the application of phenol or silver nitrate to the HGT or removal of the offending nail spike is sufficient to allow for the resolution of the peri-ungual swelling 3,16,17 . In contrast, Markinson 18 asserts that sharp resection speeds up the overall healing process, improves the cosmetic result, and states that this is a common practice in American podiatry clinics, but as noted by Reilly and Burt6, this technique is not well examined in the literature. ...
Ingrown toenails are a commonly occurring foot complaint. The condition occurs when the nail plate pierces the sulcus, giving rise to pain, inflammation and infection. As the skin attempts to heal itself, hypergranulation tissue may form. This is a case report of phenolic nail surgery treatment employed for a stage 3 bilateral onychocryptosis with sharp resection of hypergranulation tissue performed in only one (the lateral) of the two affected sulci. Sharp resection of the residual medial hypergranulation tissue was performed two months after the index procedure when this had not resolved. The case highlights the potential role of sharp resection in improving treatment outcomes.
... Hypergranulation tissue (HGT) is defined as an excess of granulation tissue and is precipitated by an aberrant inflammatory phase caused by infection or the presence of foreign bodies [3], such as a nail spicule. The HGT itself is a vascularized edematous stroma containing a mixed infiltrate of inflammatory cells [4] and continues to be produced until the nail is removed [5]. ...
... When wound healing is chronic, the tissue repair and tissue remodelling stages occur simultaneously, which results in fibrosis of the granulation tissue, thereby replacing normal tissue with scar tissue [63]. The fibrotic appearance of the granulation tissue affecting the nail fold of an IGTN is a common association [5]. The authors, therefore, wonder whether the chronicity or the histological components of the HGT, at different wound healing intervals, is a key determinant in the success of using AgNO 3 for HGT. ...
Silver compounds have been used in medicine to treat infections, open wounds, and chronic ulcers. Silver nitrate is used as a caustic, antiseptic, haemostatic and astringent agent. Using high-strength silver nitrate to treat the hypergranulation tissue complicating ingrown toenails is a customary practice by podiatrists in the United Kingdom. This study aims to identify what primary literature is available concerning the use of silver nitrate in this scenario, as anecdotal evidence suggests that its efficacy is limited. A scoping review of the literature was performed. The senior author searched electronic databases for primary studies and completed the independent screening process. The search identified 325 studies. After the rejection of those that were not relevant, a full-text review of 22 studies was performed. 21 studies were rejected as irrelevant, and one study was included. The second author then performed a free text search on Google and Google Scholar and found two further articles. In conclusion, this review found very little evidence to support the use of silver nitrate for treating the hypergranulation tissue affecting ingrown toenails.
... The skin's attempt at healing leads to the formation of hypergranulation tissue (HGT) -vascularized oedematous stroma containing a mixed infiltrate of inflammatory cells 2 , which continues to be produced until the nail is removed 3 . Multiple staging systems for IGTNs exist, but most describe a variation of the original classification put forward by Heifetz 4 : • Stage I: erythema and swelling of the lateral nail fold, • ...
... Nail surgery techniques for permanent removal of part or all of a nail fall into two categories, the latter with the use of phenol being the most popular 5 : 1. Excision of the pathological nail/soft tissue by the use of sharp instrumentation (cold steel/incisional procedures), 2. Destruction of the pathological tissue by physical means such as topical chemotherapy (phenol), freezing, electro-galvanism, burring or lasering. Reilly and Burt 6 note that only a brief mention is made in the literature of performing sharp resection of the HGT at the time of nail surgery 1,3,[7][8][9][10][11] . Within the UK Podiatry profession, concurrent sharp resection of the HGT is not common practice 12 . ...
... Some authors suggest that the application of phenol or silver nitrate to the HGT or removal of the offending nail spike is sufficient to allow for the resolution of the peri-ungual swelling 3,16,17 . In contrast, Markinson 18 asserts that sharp resection speeds up the overall healing process, improves the cosmetic result, and states that this is a common practice in American podiatry clinics, but as noted by Reilly and Burt 6 , this technique is not well examined in the literature. ...
Abstract: Ingrown toenails are a commonly occurring foot complaint. The condition occurs when the nail plate pierces the sulcus, giving rise to pain, inflammation and infection. As the skin attempts to heal itself, hypergranulation tissue may form. This is a case report of phenolic nail surgery treatment for a bilateral presentation with sharp resection of hypergranulation tissue performed in only one (the lateral) of the two affected sulci. Sharp resection of the residual medial hypergranulation tissue was performed two months after the index procedure when this had not settled. The case highlights the potential role of sharp resection in the overall improvement of treatment outcomes.
... A study conducted in Australia showed that more than 20% of surgeries for the feet were performed for ingrown toenails (4). Excessive perspiration, improper nail trimming, trauma, tight shoes, and socks play a role in the etiology (5). The growth of the nail plate into the adjacent nail fold damages the soft tissue and causes an inflammatory reaction characterized by excessive granulation tissue formation (1,2). ...
... ResultsGeneral satisfactions, mean ± SD 4.7±0.5 4.5±0.6 0.145 Back to work/school time, mean ± SD 14.4±1.4 ...
... Ingrown toenails are most common among school-age children and adolescents though they can be encountered at any age [1]. The great toe is most commonly affected, especially the right great toe, which is subjected to greatest pressure when walking or running [2,3]. Causes of ingrown toenails include excessive skin surrounding the nail and excessive curvature(a hereditary factor), trauma, and external pressure(an acquired factor). ...
... If symptoms are not severe, conservative treatment is performed using a gutter splint, dental floss, cotton-wick, or band. However, if symptoms are severe or persist, surgical treatment is performed [2,4,5]. Nevertheless, high recurrence rates have been reported after surgery, and thus, the author attempted to devise a more permanent surgical method. ...
... Stage 2 is characterized by symptom exacerbation, oozing, and infection, and in stage 3, symptoms are further aggravated, and hypertrophy of granulation tissue and lateral nail folds is evident. The present case was of stage 3 [2,3]. ...
Ingrown toenails are most common among school-age children and adolescents though they can be observed at any age. Causes of ingrown toenails are increased curvature, trauma, and external pressure. Treatment of ingrown toenails can be broadly characterized as conservative and surgical. Conservative treatment can be performed using various methods, such as a gutter splint, dental floss, and cotton. Surgical treatments may be divided into two main approaches; narrowing of the nail plate and debulking of periungual tissues. However, these various conservative and surgical treatments have high recurrence rates, and thus, the author used a permanent surgical method based on the use of a paronychium flap to treat a 15-year-old male adolescent with excessive periungual tissues and curved ingrown toenails who did not improve despite conservative and several surgical treatments over 4 years. Subsequently, toenail shape was maintained without recurrence 22 months after surgery, and there were no complaints of inflammation or pain while walking. This simple surgical method can be performed on patients with advanced ingrown toenails due to excessive periungual tissues and nail curvature and can be expected to have permanent effects.
