Abstract Ingrown nails mainly affect the great toes, much less frequently lesser toes and rarely fingers. There are many speculations as to their etiology and pathogenesis; however, at the end, there is almost always a imbalance between too wide the nail plate and too narrow the (distal) nail bed. Ingrown nails occur at all age periods, from newborns to the over-100s though with different frequency, clinical characteristics, and management options. In recent years, conservative treatment options – taping, packing, gutter, braces, and many more - were developed avoiding the often disfiguring results of inadequate surgery. However, they require consistent and long-term therapy. Surgery is either aimed at narrowing the wide nail plate or reducing the hypertrophic lateral nail folds. The number of operation methods is vast; already 150 ago, more 75 different surgical techniques had been known, and there is virtually a new one published every week. Despite ingrown nails being a matter of concern for medical doctors since antique, new aspects continue to be detected, such as retronychia. Further, it was found that orthopedic foot abnormalities are very frequently seen in association with ingrown nails. Their treatment is often necessary to prevent recurrences.
Nails, Ingrown

INTRODUCTION: Ingrowing toenail (IGTN) or onychocryptosis is not uncommon in children and adolescents. However, there is a dearth of evidence in the literature on the management of IGTN in this age group. This study aimed to compare the results of nonoperative treatment for IGTN with that of operative treatment among children and adolescents. METHODS: All children and adolescents who were treated for IGTN at our institution between 2010 and 2014 were included for this retrospective study. Demographic data, treatment prescribed and outcome at six months after presentation were analysed. RESULTS: Overall, 199 patients were recruited. There were 123 (61.8%) boys and 76 (38.2%) girls. Median age was 14 years. Among 199 toes, 162 (81.4%) were treated nonoperatively, with nail care advice, topical antibiotics and daily cleansing. Only 37 (18.6%) toes were treated operatively. In the operative group, 23 (62.2%) patients underwent wedge resections, while the remaining 14 (37.8%) had total nail avulsions; for all patients, germinal matrices were preserved. At the six-month follow-up, there were 5 (3.1%) cases of recurrence in the nonoperative group when compared to 3 (8.1%) recurrences in the operative group. CONCLUSION We recommend that IGTN in children and adolescents be treated in the first instance by nonoperative methods. Operative options can be considered for resistant cases or in case of recurrence of IGTN.
Adolescent ; Anti-Bacterial Agents ; therapeutic use ; Child ; Female ; Hospitals, Pediatric ; Humans ; Male ; Nails ; Nails, Ingrown ; drug therapy ; surgery ; Recurrence ; Retrospective Studies ; Singapore ; Toes

PURPOSE: An ingrown nail is common in military trainees who are exposed to highly demanding activities. Although the matrixectomy procedure has been the main treatment modality, several drawbacks may follow after the procedure, such as infection, periostitis, and continued pain that causes a delayed return to duty. This study examined the outcomes of a simple partial nail extraction with the hypothesis that this procedure may bring an earlier return to duty, lower the perioperative complications, and produce a comparable recurrence rate. MATERIALS AND METHODS: The medical records of patients who had surgical treatment for an ingrown nail in the authors' institution between April 2016 and December 2017 were reviewed retrospectively. Under the inclusion and exclusion criteria, 28 patients with a simple partial nail extraction (group A) and 29 patients with a partial nail extraction with matrixectomy (group B) were investigated. As the clinical outcome, the visual analogue scale (VAS) and satisfaction score, time to return to duty, complications, and recurrence rate were checked and compared between the groups. RESULTS: The VAS scores of group B were significantly higher during the first (p<0.001) and second (p=0.026) follow-up week than group A. The time to return to duty was shorter in group A (7.8 days) than group B (10.1 days), and this difference was significant (p<0.001). Group B had five patients with complications, whereas group A had none (p=0.028). No differences in the recurrence rate (p=0.197) and patient satisfaction (p=0.764) were found between the groups. CONCLUSION: In this study, simple partial nail extraction in military trainees resulted in lower postoperative pain, lower complication rates, and earlier return to duty than the procedure with matrixectomy. Military trainees are temporarily exposed to highly demanding activities. Thus, a satisfactory outcome would be expected with simple partial nail extraction without performing a radical procedure, such as a matrixectomy.
Follow-Up Studies ; Humans ; Medical Records ; Military Personnel ; Nails, Ingrown ; Pain, Postoperative ; Patient Satisfaction ; Periostitis ; Recurrence ; Retrospective Studies ; Toes

PURPOSE: Ingrown toenails are a common disease in the adolescent period and the treatments could be more conservative for this early stage of the disease. This study is a case series on the results of a gutter splint for an adolescent ingrown toe nail as a simple, comfortable treatment method. MATERIALS AND METHODS: From 2011 to 2018, 22 patients (mean age, 12.2 years; range, 8~15 years) with ingrown toenails were treated with a gutter splint. There were 16 boys and 6 girls with 7 patients on both great toes, and additional 4 both corners of a nail, giving a total of 33 splints. Flat, plastic straws and glue or suture were used to protect the nail corners under local anesthesia. The medical records were reviewed retrospectively and phone calls were made to obtain the long-term results. RESULTS: Fifteen splints were fixed with a suture and the other 18 splints were fixed with glue. There were 9 cases of recurrence out of 33 gutter splints, 8 out of 15 sutured splints and 1 out of 18 glued splints (p=0.010). There was no gender (p=0.383) or age (p=0.305) difference in the number of recurrences. CONCLUSION: For growing people, ingrown nails can be cured easily by conservative treatment for a transiently shortened or broken toenail. The glued gutter splint had a reasonable success rate as a first line treatment.
Adhesives ; Adolescent ; Anesthesia, Local ; Female ; Humans ; Medical Records ; Methods ; Nails ; Nails, Ingrown ; Plastics ; Recurrence ; Retrospective Studies ; Splints* ; Sutures ; Toes*

BACKGROUND: Pincer nail deformity is a transverse overcurvature of the nail. This study aimed to define the anatomical characteristics of pincer nail deformity and to evaluate the surgical outcomes. METHODS: A retrospective review was conducted on 20 cases of pincer nail deformity of the great toe. Thirty subjects without pincer nail deformity or history of trauma of the feet were selected as the control group. Width and height indices were calculated, and interphalangeal angles and base widths of the distal phalanx were measured with radiography. We chose the surgical treatment methods considering perfusion-related factors such as age, diabetes mellitus, kidney disease, and peripheral vascular disease. The zigzag nail bed flap method (n=9) and the inverted T incision method (n=11) were used to repair deformities. The outcomes were evaluated 6 months after surgery. RESULTS: The interphalangeal angle was significantly greater in the preoperative patient group (14.0degrees+/-3.6degrees) than in the control group (7.9degrees+/-3.0degrees) (P<0.05). The postoperative width and height indices were very close to the measurements in the control group, and most patients were satisfied with the outcomes. CONCLUSIONS: We believe that the width and height indices are useful for evaluating the deformity and outcomes of surgical treatments. We used two different surgical methods for the two patient groups with respect to the perfusion-related factors and found that the outcomes were all satisfactory. Consequently, we recommend taking into consideration the circulatory condition of the foot when deciding upon the surgical method for pincer nail deformity.
Congenital Abnormalities* ; Diabetes Mellitus ; Foot ; Humans ; Kidney Diseases ; Nails, Ingrown ; Onychomycosis ; Osteophyte ; Peripheral Vascular Diseases ; Radiography ; Retrospective Studies ; Toes

BACKGROUND: An ingrown nail is a common condition of inflammation and infection that can occur when nails are clipped too much or pressure is applied by tight shoes. In Korea, a study on the success of tube insertion after nail guttering has been reported, but studies including other treatments are lacking. OBJECTIVE: To evaluate the success rates of three treatments for ingrown nails: 1) nail splinting via a flexible tube; 2) partial nail extraction and electrocautery; or 3) partial nail extraction and phenol cauterization. METHODS: Fifty-one patients who underwent nail splinting via a flexible tube or partial nail extraction followed by either electrocautery or phenol cauterization of the nail matrix over a 6-year period at our hospital were evaluated for treatment outcome. The disease severity was classified using the Heifetz grading scale. We evaluated the success rates of the various treatments according to reduced disease severity. Treatment failure was defined as persistence or re-occurrence of disease symptoms. RESULTS: 1. Out of 51 cases of ingrown nails, 31 (60%) showed no recurrence after treatment. 2. There were conflicting results between the severity grade and success rate. 3. Treatment via partial nail extraction and either electrocautery or phenol cauterization was more effective (success rates of 63% and 60%, respectively) than nail splinting via a flexible tube (56% success rate). However, the results were not statistically significant. CONCLUSION: Selecting the proper therapeutic method is important for successful treatment of an ingrown nail.
Cautery ; Electrocoagulation ; Humans ; Inflammation ; Korea ; Nails, Ingrown* ; Phenol ; Recurrence ; Shoes ; Splints ; Treatment Failure ; Treatment Outcome

BACKGROUND: Many techniques for the treatment of ingrown toenails have been described in the medical literature. Surgical removal of the nail plate with partial matricectomy is associated with the lowest recurrence rates. Shape-memory alloy (KD wire) has shown promising results for the treatment of ingrown toenails. However, the results of long term follow-up or a comparison with surgical treatment have not been reported, and the adequate removal time of the wire remains unknown. OBJECTIVE: To compare the results of surgical treatment using partial matricectomy (PM) to those of conservative treatment using KD wire (KD) and to determine the adequate removal time of the wire. METHODS: The KD and PM groups were compared regarding pain relief, quality of life improvement, pain and discomfort during the procedures and 3 weeks after, improvement of nail index by using clinical photos, and patient's satisfaction with the treatments. The nail index improvement in the KD group was compared between postprocedural days 14 and 21. RESULTS: Recurrence was higher (p=.039) in KD group (18.64%) than PM group (6.35%). Patient satisfaction was significantly better (p=0.025) in the PM group than in the KD group. Other parameters showed no significant differences between the two groups. Nail index improvement in the KD group was not significantly different between postprocedural day 14 and day 21. CONCLUSION: Conservative treatment using the KD wire is as effective as surgical removal with partial matricectomy for the treatment of ingrown nails in pain relief, QOL improvement and nail index improvement, but has higher recurrence. The adequate application period of KD is 2 weeks.
Alloys* ; Follow-Up Studies ; Memory* ; Nails* ; Nails, Ingrown ; Patient Satisfaction ; Quality of Life ; Recurrence

BACKGROUND: Ingrown toenail is one of the most common nail complaints. It occurs mostly on the great toes, where is an excessive lateral nail growth into the nail fold, leading to painful irritation, inflammation, and growth of the granulation tissue. Many treatments have been described, but these classic treatment modalities may lead to severe damage of the nail fold or frequent relapses. OBJECTIVE: We attempted to evaluate the therapeutic efficacy of super elastic wire (SE-wire, Machiwire(R)), a non-invasive treatment for ingrown toenails. METHODS: Fifteen patients with ingrown toenail were treated with super elastic wire. Objective assessment was evaluated by use of the width index (width of the nail tip/width of the nail root) and height index (height of the nail tip/width of the nail root). Subjective assessment was evaluated by use of a visual analogue scale declared by patients. In addition, wound complications and recurrence were described. RESULTS: The width index and height index were improved (width index: 75.0%-->90.0%, height index: 76.5%-->27.7%). Pain was relieved in 100% of the cases. For subjective assessment, all of the patients were satisfied (more than "satisfactory": 100%). There were two relapsed cases during 5 to 12 month period (mean time: 9 months). CONCLUSION: We recommend super elastic wire method as an alternative treatment for ingrown toenail, because it is simple, easy to perform, noninvasive, effective, and well-tolerated.
Granulation Tissue ; Humans ; Inflammation ; Nails ; Nails, Ingrown ; Recurrence ; Toes

An ingrown toenail, which causes pain especially with secondary infection, and is one of the most common diseases of toenails. It becomes difficult for a patient to walk and this subsequently impairs the quality of life. Surgical procedures, including total or partial excision of the nail bed, phenolization and the carbon dioxide laser matricectomy method, are commonly performed to treat this problem. The disadvantages of these methods include their complexity, the pain, the time required to do the procedure and the need for local anesthesia during the operation. We present here successful therapy for a patient with ingrown nails with using a super elastic wire (SE-wire, Machiwire(R)). To the best of our our knowledge, this is the first case that describes the clinical benefits of the SE-wire for the treatment of ingrown nails in a Korean patient.
Anesthesia, Local ; Coinfection ; Humans ; Lasers, Gas ; Nails ; Nails, Ingrown ; Phenol ; Quality of Life

An ingrown toenail, which causes pain especially with secondary infection, and is one of the most common diseases of toenails. It becomes difficult for a patient to walk and this subsequently impairs the quality of life. Surgical procedures, including total or partial excision of the nail bed, phenolization and the carbon dioxide laser matricectomy method, are commonly performed to treat this problem. The disadvantages of these methods include their complexity, the pain, the time required to do the procedure and the need for local anesthesia during the operation. We present here successful therapy for a patient with ingrown nails with using a super elastic wire (SE-wire, Machiwire(R)). To the best of our our knowledge, this is the first case that describes the clinical benefits of the SE-wire for the treatment of ingrown nails in a Korean patient.
Anesthesia, Local ; Coinfection ; Humans ; Lasers, Gas ; Nails ; Nails, Ingrown ; Phenol ; Quality of Life