Ingrowing Toenail

Epidemiology

• Almost always affects the great toe
  
• Male > Female
  
• Typically occurs in adolescents or young adults
  
• Can also occur in older patients, often diabetics

Aetiology

• Poor nail cutting technique – too short with sharp edges
  
• Tight-fitting footwear
  
• Thick socks & sweating
  
• Supinated big toe
  
• Other foot deformities putting pressure on the big toe edge
  
• Medications & systemic diseases
  • e.g., HIV, cyclosporin

Clinical Features

• Red, purulent, painful nail edge
  
• Can be medial or lateral
  
• Hypergranulation tissue
  
• Often bilateral

Classification

• Grade 1 – Redness, no discharge
  
• Grade 2 – Discharge and infection
  
• Grade 3 – Hypergranulation tissue, infection, and discharge

Management

Non-Operative

• Grade 1
  • Sterile soaks
    
  • Education on proper nail cutting technique
    
  • Podiatry care
    
  • Antibiotics if acute infection

Surgical

• Recalcitrant Grade 2 or Grade 3 cases
  
• Technique
  • Cochrane review (2005) indicates the best treatment is:
    • Wedge or whole nail resection with phenol ablation of the matrix
      
    • Minimizes recurrence rates

Complications

• Soft tissue burns from phenol
  
• Abnormally shaped nail in the future
  
• Recurrence