Author: Bertrand Richert
Affiliation: Dermatology Department, Université Libre de Bruxelles, University Hospital Brugmann – Saint Pierre – Children Hospital Queen Fabiola, Brussels, Belgium
Abstract
Despite numerous publications, the debate on the causes and treatments of ingrown toenails persists. Surgical interventions are primarily divided into two strategies: narrowing the nail plate or debulking the soft tissues. This article evaluates the effectiveness of these approaches and emphasizes that the success of surgical treatments is highly dependent on proper execution and experience.
Introduction
The issue of ingrown toenails is frequently discussed in the fields of podiatry, dermatology, and orthopedics. Different theories on the causation have led to varied treatment strategies, either focusing on the nail itself or the surrounding soft tissues. This paper reviews historical classifications by Baran and addresses surgical interventions for cases resistant to conservative treatments or characterized by extreme discomfort.
Development of Ingrowing Toenails
Contrary to some beliefs, recent studies show no abnormality in forefoot alignment in patients with symptomatic ingrowing toenails. The condition often results from improper nail care, such as cutting nails too short, which may lead to nail spurs causing pain and infection.
Surgical Techniques
Definitive Narrowing of the Plate
Chemical Cautery: The most common approach involves chemical matricectomy using phenol, which offers a high success rate and is noted for its simplicity and efficacy in preventing recurrence.
Debulking of the Periungual Soft Tissues
Howard–Dubois' Procedure: This method involves removing excess soft tissue to relieve the pressure on the nail plate, proving particularly effective in cases of distal embedding.
Conclusion
The treatment of ingrown toenails requires a thoughtful approach to determine whether the nail plate or the periungual tissues are the primary contributors to the condition. With a variety of surgical options available, the choice of procedure should be tailored to the specific needs of the patient and the expertise of the surgeon.
