Deviation of the Nail Lamina after Unilateral Partial Matricectomy.

Deviation of the nail plate in the transverse plane has traditionally been regarded as a postoperative complication following the definitive surgical treatment of ingrown toenails, particularly when only a single nail fold is addressed. The quantification and longitudinal comparison of the operated versus non-operated nail folds could elucidate potential transverse deviations of the nail plate. The objective of this study was to assess the presence or absence of transverse nail plate deviation following ingrown toenail surgery on a single nail fold. METHODS: A cohort of 11 patients (three males, eight females) with recurrent ingrown toenails undergoing unilateral partial matricectomy were included in this study. Preoperative measurements were compared to those taken at 7, 14, 21, 28, and 35 days postoperatively. RESULTS: The analysis revealed no statistically significant differences in measurements between the operated and non-operated nail folds, nor were there significant changes in the measurements over time within each group (p > 0.05). CONCLUSIONS: Despite the absence of visible deviations in the orientation of the nail plate, the angular measurements post-surgery at 35 days showed no statistically significant alterations. The angular values observed across all time points appeared to be influenced by the intrinsic morphological characteristics of each nail plate.

Effect of using a kinetic wedge during the hallux dorsiflexion resistance test in asymptomatic individuals.

BACKGROUND: The hallux dorsiflexion resistance test is a frequently employed clinical maneuver for assessing the initiation of the windlass mechanism This maneuver involves dorsiflexion of the phalanx of the hallux, thereby evaluating plantarflexion of the first metatarsal, elevation of the medial longitudinal arch, and supination of the rearfoot. The windlass mechanism plays a crucial role in gait, and orthopedic devices, such as a kinetic wedge, which aims to facilitate its activation by increasing the hallux dorsiflexion. Although it is believed that facilitating the windlass mechanism with the kinetic wedge should be directly correlated with a decrease in hallux dorsiflexion resistance, its effects have yet to be characterized. Thus, this study aimed to determine the influence of a kinetic wedge on hallux dorsiflexion resistance in asymptomatic individuals. METHODS: The sample comprised thirty participants (14 women and 16 men). A digital force gauge measured the force required to perform the hallux dorsiflexion resistance test during two conditions: barefoot and with a kinetic wedge. The Wilcoxon signed-rank test was used to compare the hallux dorsiflexion resistance between conditions. RESULTS: A statistically significant reduction in force (10.54 ± 3.16N vs. 19.62 ± 5.18N, p < 0.001) was observed when using the kinetic wedge compared to the barefoot condition during the hallux dorsiflexion resistance test. CONCLUSION: The use of a kinetic wedge reduces the required force for performing the passive hallux dorsiflexion resistance test in asymptomatic individuals. Future studies should determine to what extent the kinetic wedge can attenuate the required force to dorsiflex the hallux in individuals with musculoskeletal disorders such as plantar fasciopathy and functional hallux limitus.

Operative Management of Y-Shaped Metatarsal with Biphalangeal Sixth Toe.

BACKGROUND: In the literature, there is no consensus regarding the surgical management of postaxial polydactyly, and few cases of polymetatarsia with polydactyly have been reported. Treatment of the complete deformity will prevent further foot and gait disorders. OBJECTIVE: To identify literature relevant to the operative management of Y-shaped metatarsal with biphalangeal sixth toe and related skin and wound care to improve surgical treatment protocols from a clinical experience perspective. DATA SOURCES: The authors searched several electronic databases in December 2022 for articles related to postaxial polysyndactyly in the feet and polymetatarsia. Databases searched included PubMed, SciELO, ScienceDirect, Cochrane Database of Systematic Reviews, and Google Scholar gray literature. STUDY SELECTION: Two independent researchers conducted the searches and read the article titles and abstracts. Studies were included if they were narrative reviews, case studies, or observational studies; written in English or Spanish; and published between 2012 and 2022. Nonhuman studies were excluded. Studies that met the inclusion criteria were fully evaluated. Disagreements between reviewers were resolved by consensus, and when there was no consensus, a senior researcher was consulted. DATA EXTRACTION: The following data were extracted from the included studies using a standardized form: author and year of publication, study type, number of participants, sex, polydactyly location, polymetatarsia, type of polydactyly, participants' history of hereditary associated diseases or malformations, treatment, removal criteria, and timing of surgery. DATA SYNTHESIS: Authors evaluated 11 studies of postaxial polydactyly that included a total of 153 participants (64 men, 89 women). They also document their clinical experience with a surgical technique used in cases of bilateral postaxial polydactyly of the foot with a Y-shaped metatarsal with biphalangeal sixth toe. CONCLUSIONS: Surgical correction with lateral removal of the sixth toe is a resolutive treatment to improve the functionality of the foot, its aesthetic appearance, and the patient's quality of life. Case-specific treatment should be applied and tailored to meet the individual needs. The biomechanics of gait and shoe problems in these patients improve with surgical treatment, without presenting secondary aesthetic problems in skin care.

Polyethylene Nail Brace for Ingrown Toenails Treatment: A Randomized Clinical Trial.

Background: Onychocryptosis is one of the most prevailing onychopathies and one of the usual reasons for visiting podiatry clinics. In this research, we aim to evaluate the effectiveness of a procedure of nail reeducation technique via a strip of polyethylene in subjects with stage I or IIa onychocryptosis, in which pathological toenail curves are present. Methods: This research was a randomized clinical trial (ACTRN12615000834550). The sample was made up of 94 cases of stage I or IIa onychocryptosis, according to the Mozena classification. Briefly, 46 cases were treated with the combination of a spicule technique and nail brace with a polyethylene plastic strip, and 48 were only treated with the spicule technique. Results: The combination of the spicule technique and the nail brace technique with a strip of polyethylene had a significantly lower recurrence rate compared to that achieved with just the spicule technique, twelve months after the beginning of the study (N.S. = 0.000 for α = 0.05). The change in the nail width achieved with the nail brace technique, twelve months after the beginning of the study, was statistically significant (N.S. = 0.000 for α = 0.05). Conclusions: The recurrence rate of the spicule technique alone was significantly higher than the combined technique of spicule with nail brace. A nail brace with a strip of polyethylene reduces the recurrence rate of onychocryptosis.