Ingrown Toenail/ Chronic Paronychia
Etiology
0.5 to 1mm space between the lateral nail fold and lateral margin of the nail. Space is reduced with trauma, compression from shoes or other extrinsic pressure
Reactive swelling leads to hyperplasia and hypertrophy
Toenail margin cuts in to the lateral nail fold causing a foreign body reaction and possible secondary infection
Ingrown toenails/conservative treatment 70% efficacy
Loose fitting stockings and shoes decrease pressure
Cut toenails straight across
No evidence for V shape cut in center
Hot soapy soaks 3 x day for early symptoms
More conservative treatment : Dental floss under nail edge
Wedge small piece of packing with sharp point of wooden stick or small instrument
If too inflamed will need a digital block
Ingrown toenails: Best Referred out if possible! Can you justify the time and do you have correct supplies (phenol, freer elevator, etc)?
How to treat in your clinical setting without referral
Partial nail plate avulsion
Digital block, may need only partial block if medial side
Soak nail to soften
Elevate nail with Freer elevator or carefully separate with scissors
Cut nail edge longitudinally, remove section with hemostat inspecting for nail remnants
Cauterize matrix with phenol, silver nitrate or cautery
Pain meds, possible antibiotics
Soak 2 x day in Epsom salts
Nail elevation as nail grows out
Instructional ingrown toenail procedure video (no sound)
http://www.youtube.com/watch?v=XVDYb6ubt7I