Conservative management of a severe case of onychocryptosis at a podiatric clinic-A case report.

BACKGROUND: Onychocryptosis, also known as ingrown toenails or ungues incarnati, is a fairly frequent condition, with global prevalence of approximately 20%. OBJECTIVES: This study is aimed at discussing possible conservative management of severe onychocryptosis, with a case report. METHODS: Conservative approach is effective in reducing or even entirely correcting underlying nail deformities. Eliminating nail fold inflammation is necessary prior to the bracing procedure. The non-surgical approach combined with proper wound treatment of the involved nail folds is a promising alternative for a growing number of patients. RESULTS: Nail plate deformities may be largely corrected or fully eliminated. As demonstrated by our case report, even advanced stages of onychocryptosis may be effectively treated with nonsurgical modalities. CONCLUSION: Proper podiatric care facilitates conservative approach to management of ingrown toenails, improving the patient's overall wellbeing and eliminating pain. The prerequisite for nonsurgical correction of the nail plate is treating inflammation first. Conservative correction is more aesthetically pleasing and less emotionally disturbing to the patients than partial or complete surgical avulsion. Lesser invasiveness is an advantage especially in the case of patients with chronic comorbidities.

Onychocryptosis - decrypting the controversies.

Onychocryptosis, or ingrown toenail, is a frequent, painful condition affecting young individuals. Controversies still exist regarding its etiopathogenesis and treatment options, including conservative and surgical techniques. The choice of treatment method depends on the stage of disease as conservative measures are mostly effective in early stages and surgical procedures are required in the later stages. Among surgical techniques, phenol cauterization of lateral nail matrix has been the most effective, safe, and commonly performed method. Other more destructive surgical procedures are rarely done nowadays. In this review, we briefly discuss the etiopathogenesis, clinical features, and different treatment options of ingrown toenail.

Review of onychocryptosis: epidemiology, pathogenesis, risk factors, diagnosis and treatment.

Ingrown toenail, or onychocryptosis, is a highly prevalent nail condition that occurs when the nail edge grows into the periungual dermis. It most frequently affects the hallux and has a biphasic presentation, being most common in the second and fifth decades. It is often painful and may be debilitating in severe cases. Risk factors include trauma, weight changes, poor nail-cutting technique, and hyperhidrosis. Both conservative and surgical treatments have been described, and choice of therapy is dependent on patient co-morbidities, severity, and associated symptoms. This review covers the epidemiology, risks factors, pathogenesis, evaluation, and staging of ingrown toenails, as well as, treatment options. Although there is an unmet need for clinical trials comparing therapies, current recommendations are to treat conservatively and then proceed to surgical therapies if symptoms persist.

Clinical and Sociodemographic Characteristics of Ingrown Nails in Children.

BACKGROUND: Ingrown nail is a condition frequently seen in children and adolescents, the pain from which can affect their daily living activities and school performances. The purpose of this study was to determine the clinical and sociodemographic characteristics of ingrown nails in children. METHODS: The clinical and sociodemographic characteristics of patients aged 0 to 18 years presenting with ingrown nail were evaluated retrospectively from clinic records. RESULTS: Sixty-two patients aged 3 to 18 years (mean age, 15 years; male to female ratio, 1.06) were enrolled. A total of 175 ingrown nails were evaluated (all of them were in the halluces, 54.3% of them were on the lateral margin). A positive family history of ingrown nail was present in 15.7%. High prevalences of incorrect nail cutting (72.1%), trauma (36.1%), poorly fitting shoes (29%), hyperhidrosis (12.9%), obesity (9.7%), and accompanying nail disorders (9.7%) were determined among the patients. CONCLUSIONS: This study revealed the clinical and sociodemographic characteristics of ingrown nails in children. These data will be useful in preventing the occurrence of ingrown nail by revealing and then eliminating predisposing factors.

Clinical and Sociodemographic Characteristics of Patients with Ingrown Nails.

BACKGROUND: Ingrown nail is a common health problem that significantly affects daily life due to its painful nature. The purpose of this study was to reveal the clinical and sociodemographic characteristics of ingrown nails. METHODS: The clinical and sociodemographic characteristics of patients older than 18 years presenting with ingrown nail were investigated. RESULTS: Two hundred six patients aged 18 to 77 years (mean age, 39 years; female to male ratio, 1.45) were included in the study. A total of 729 lesions were evaluated (718 ingrown nails were on the feet and 11 were on the fingers). A family history of ingrown nail was present in 7.6% of the participants. Of the 206 patients, 26.7% were treated with surgical methods for ingrown nails previously and experienced recurrence. Ingrown toenails were in the hallux in 81.3% of patients, and 52% were on the lateral margin. Incorrect nail-cutting habits (73.5%), poorly fitting shoes (46.2%), excessive angulation of the nail plate (35.8%), obesity (34.1%), trauma to the feet (24.3%), pregnancy (23.8% of women), hyperhidrosis (16.8%), and lateral deviation of the nail plate (9.9%) were closely associated with ingrown nails. CONCLUSIONS: This study revealed the clinical and sociodemographic characteristics of ingrown nails. The study data will be useful in preventing the development of ingrown nail and recurrences after treatment by identifying and then eliminating conditions establishing a predisposition to it.

Retronychia of the toenails: a review with emphasis on pathogenesis, new diagnostic and management trends.

Retronychia is a condition, first described in 1999, characterized by the embedding of the proximal nail plate into the proximal nail fold and the stacking of a multiple generations of nail plates beneath the proximal nail fold. The disease affects frequently the toenails and is associated with stress-relevant situations including repetitive trauma, ischemic etiologies, postpartum, and compartment syndrome. Predisposing factors including static disorder of the feet may be underestimated. The paucity of data regarding the predisposing factors is because existing studies are limited to small case reports, case series, and retrospective studies. The diagnosis is clinical, which could be challenging because retronychia can easily mimic other nail disorders with chronic paronychia. Since the first description, significant advances have been made regarding diagnostic criteria including ultrasonography. We performed a systematic review of the literature on retronychia from inception to April 2018 with an emphasis on the pathogenesis and new diagnostic and management trends.

Ingrown Toenails During Chemotherapy and Stem Cell Transplantation in Children With Hematologic Malignancies and Solid Tumors.

BACKGROUND: At our institution, we noted that children with hematologic malignancies and solid tumors often suffered from ingrown toenails (IGTNs) during hospitalization for chemotherapy and stem cell transplantation. However, only few reports have dealt with IGTNs in the above setting. PROCEDURE: Between August 2007 and July 2017, 180 children who received treatment for hematologic malignancies and solid tumors at our institute were enrolled in this study. Twelve patients with insufficient data and 7 patients with past histories of IGTNs were excluded. A total of 161 patients were analyzed. Median age at admission was 7.9 years (range, 1.0 to 25.4 y), with 92 males and 69 females. Diagnoses were hematologic diseases in 128 patients, including acute lymphoblastic leukemia (ALL) in 75 patients, and solid tumors in 33 patients. RESULTS: A total of 22 patients (13.7%) suffered from IGTNs (or toe paronychia) during hospitalization. Multivariable analysis disclosed a strong correlation between the occurrence of IGTNs and older age (over 9.0 y) and ALL. CONCLUSIONS: Patient-related factors, such as age over 9 years and ALL were associated with IGTNs. This is the first report of a survey on IGTNs in patients with hematologic malignancies and solid tumors hospitalized for chemotherapy and stem cell transplantation.

Paronychia with Sporangium Formation Causing an Ingrown Toenail A Rare Case Report.

Ingrown toenail, or onychocryptosis, is a common inflammatory disease of the hallux. It results from the alteration of fit of the nail plate in the lateral nail fold. Ingrown toenails are usually seen in adolescents and young adults and can affect daily activities and social life. Generally, ingrown toenails are classified into three stages, including the inflammatory stage, the abscess stage, and the granulation stage. In this article, we present the rare case of a man with a diagnosis of paronychia with sporangium formation causing an ingrown toenail.

Posttraumatic Retronychia of the Foot with Clinical and Ultrasound Correlation.

Retronychia, the posterior embedding of the nail bed into the proximal nail fold, can be a complex clinical dermatologic diagnosis that may mimic other inflammatory ungual diseases or tumors of the nail. It has been related to a history of severe systemic conditions that secondarily affect the nail matrix and is commonly associated with onychomadesis. We present a case of retronychia of the foot with a purely traumatic origin, nonconcomitant with onychomadesis, that was diagnosed by color Doppler ultrasound in a long-time practitioner of martial arts who was otherwise healthy. Color Doppler ultrasound is an excellent imaging technique for supporting the diagnosis of retronychia. It provides information on the exact location and morphology of the nail plate as well as the presence of inflammatory signs in the ungual and proximal periungual regions. Additionally, this imaging technique can support the differential diagnosis with other nail conditions. Since there are many sports or activities that can potentially injure the toenails, retronychia may be an underestimated entity and the present case can raise the awareness of this condition and show the usefulness of color Doppler ultrasound.

Relation Between Nail Consistency and Incidence of Ingrown Toenails in Young Male Runners.

BACKGROUND: This study examines the possible influence of factors such as nail shape and consistency, sex, and sports activity on the development of the most common nail disorders in a population of young people. METHODS: The nail plates of 140 young people (66 females and 74 males) were studied. Of these 140 participants, 72 were runners who trained more than 10 hours a week and competed regularly, and 68 did not habitually do any sports activity. Nail shape, consistency, and disorders were examined, taking into account the sex of the participants and their sports activity. RESULTS: A hard nail consistency is more frequent in runners (74.4%) than in people who do no sports activity (25.6%). In contrast, a soft nail consistency is more prevalent in participants who do no sports activity (70%) than in runners (30%). It was also shown that onychocryptosis is related to sex, as females had a higher prevalence of this nail disorder (57.8%, P = .016). However, young male runners showed the highest and most significant percentage of the presence of onychocryptosis (74.1%; P = .002). CONCLUSIONS: Sports activity by young male runners whose nails have a hard consistency seems to be directly related to the high incidence of onychocryptosis in this population.

Relationship between the presence of abnormal hallux interphalangeal angle and risk of ingrown hallux nail: a case control study.

BACKGROUND: Many risk factors have been identified to be associated with ingrown toenail. Internal pressure by the distal phalanx of the hallux and the second toe and external compression from the shoes has been proposed as a reason for the pathology. The main objective of the study was to analyze the existence of a correlation between the presence of pathological hallux interphalangeal angle (HIA) and risk of ingrown hallux nail. METHODS: One hundred and sixty-five subjects (312 ft) were enrolled in a cross-sectional, analytical and observational case-control study. A radiographic computerized system was used to measure HIA in both groups. The angle was considered as the sum of three angles, obliquity, asymmetry and joint deviation. RESULTS: The mean HIA in case group subjects (patients with hallux ingrown nail) was significantly higher than that obtained in control group subjects (17.39 ± 6.0° versus 13.47 ± 4.6°, p = .036). A total of 73.71 and 46.79 % of feet presented an angle equal or greater than 13.47° in the onychocryptosis and control group, respectively. CONCLUSIONS: The results show a correlation between the variables analysed. The presence of an HIA greater or equal than 14.5° may be a predisposing factor for developing onychocryptosis of the hallux. Clinicians treating individuals with pathology in hallux might use a baseline cutoff of HIA equal than 13.5°.

[Ingrown nails or onychocryptosis]. / L'ongle incarné ou onychocryptose.

Ingrown nails come down to a conflict between the nail plate and the periungual tissue, causing pain, morbidity and impairment. The feet are mainly affected. The treatments are numerous: medical, podiatric, or surgical. Surgical management has two approaches: the techniques focused on the periungual skin and those on the nail plate. Among the latter, partial nail avulsion followed by matrix phenolization, known as "Boll's technique", is still highly regarded.

Physics of nail conditions: why do ingrown nails always happen in the big toes?

Although surgical treatment of nail conditions can be traced back centuries to the writings of Paul Aegineta (625-690 AC), little is known about the physical laws governing nail growth. Such a poor understanding together with the increasing number of nail salons in the high street should raise legitimate concerns regarding the different procedures applied to nails. An understanding of the physics of nail growth is therefore essential to engage with human medicine and to understand the aetiology of nail conditions. In this context, a theory of nail plate adhesion, including a physical description of nail growth can be used to determine the transverse and longitudinal curvatures of the nail plate that are so important in the physical diagnosis of some nail conditions. As a result physics sheds light on: (a) why/how nails/hooves adhere strongly, yet grow smoothly; (b) why hoof/claw/nail growth rates are similar across species; (c) potential nail damage incurred by poor trimming; (d) the connection between three previously unrelated nail conditions, i.e. spoon-shaped, pincer and ingrown nails and; last but not least, (e) why ingrown nails occur preferentially in the big toes.

[Retronychias]. / Rétronychies.

Retronychia usually affects young female (between 20 and 30 years old). It starts with the disruption of the longitudinal growth of the nail, because of a microtraumatic insult. Others diagnostic criteria: proximal nail plate rose upward proximal nailfold, pachyonychia and dyschromia, paronychia. Management consists of total nail avulsion.

Comparison of effectiveness of electrocautery and phenol application in partial matricectomy after partial nail extraction in the treatment of ingrown nails.

UNLABELLED: Ingrowing nail also known as onychocryptosis is a common health problem. This disease mostly affects young people, often carrying a considerable amount of socio-economic implications. It's foot problem that usually manifests as inflammation of tissue along the side of a toenail. The aim of the study was to asses and to compare effectiveness of electrocautery and phenol application in partial matrixectomy after partial nail extraction in the treatment of ingrown toenails. MATERIAL AND METHODS: The group of 60 patients with ingrowing toenail which was randomized into two groups underwent partial matrixectomy in surgical outpatient clinic between 2009-2013. This group of patients was under surgical observation for 100 days in outpatient clinic. RESULTS: In all operated patients we obtained surgical success however we had 13 recurrences during the follow up period, 5 in the phenolization group and 8 in the electrocoagulation group. CONCLUSIONS: There was statistically significant difference between these two techniques, which indicated that matrix phenolization is connected with shortened healing time vs the matrix electrocoagulation.

Association of hypermobility and ingrown nails.

Ingrown nail (onychocryptosis) is a common condition with severe pain and various associated morbidities. Although some underlying factors are identified, its etiology remains largely unknown. Generalized joint hypermobility (GJH) is a common entity with clinical features that might prone affected individuals to ingrown nails. Herein, we investigated the incidence of GJH in patients with ingrown nails to determine possible association between hypermobility and ingrown nail formation. Patients 16-50 years of age who were undergoing treatment for ingrown nails at the dermatology clinic were consecutively enrolled into the study. Patients with known rheumatic diseases or orthopedic foot disorders were excluded. All patients were in a pain-free period at the time of examination. The control group was comprised of age- and sex-matched healthy subjects without a history of ingrown nail. Assessment of GJH was made according to Beighton criteria. Local hypermobility was evaluated by measurement of range of motion using a goniometer. Thirty-nine patients (male/female, 17/22, mean age 31.9 ± 11.3 years) and 32 healthy subjects (male/female 12/20, mean age 31.7 ± 10.4 years) were included. Patients with ingrown toe nails were more likely to have GJH compared to healthy subjects (35.9 vs. 9.4 %, p = 0.009). Toes with ingrown nails had significantly smaller maximum dorsiflexion angles (p < 0.001) compared to toes of healthy subjects. Ingrown nail formation may be associated with GJH. However, when examined locally, there is a limited range of motion in the affected toe rather than hypermobility, which could be due to the degenerative process facilitated by the hypermobility.

Onicocriptosis en pediatría: tratamiento conservador y espiculotomía / Onichocryptosis in pediatrics: conservative treatment and spiculectomy

La onicocriptosis (de onyx, uña y kriptos, oculto) constituye elprincipal motivo de consulta por dolor ungueal.Es la penetración del borde lateral de la lámina ungueal en la pared del pliegue lateral, con dolor e inflamación del tejidocircundante.La expresión clínica oscila entre eritema, edema y dolor a lapresión del pliegue lateral, hasta la infección secundaria y la impotencia funcional.Se trata de una onicopatía mecánica, casi exclusiva del primer dedo del pie, que reconoce múltiples causas.Presentamos el manejo terapéutico en pediatría mediante medidas conservadoras y espiculotomía.