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Treatment of ingrown toenails

The ingrown toenail is a common problem. Improper nail trimming in combination with chronic trauma from tight shoes often causes ingrown toenails. A spicule of the nail plate lacerates the soft tissue of the lateral nailfold and leads to painful irritation, inflammation, infection, and growth of excessive granulation tissue. Many treatments have been described, such as nail edge separation, partial matrix phenolization, and the classic wedge excision. These classic treatment modalities may lead to severe damage of the nailfold or to frequent relapses.

Our goal was to find a treatment without producing severe nail matrix damage. Therefore, based on the technique of Wallace, Milne, and Andrew, we developed a new noninvasive therapy for ingrown toenails.

With the patient under local anesthesia, the lateral edge of the nail plate including the spicule is splinted with a lengthwise-incised small flexible plastic tube, for example, a sterile drainage tube (diameter, 2.64 mm; Sterimed) normally used after cutaneous surgery for drainage. The splint has to be pushed proximally so that the nail spicule is totally covered by the split plastic tube.

The plastic tube is then attached with wound closure strips. After this procedure, the treated toe should be washed once daily with a solution (eg, povidone-iodine) for up to 3 or 4 weeks. The splinted spicule grows out without injuring the nailfold and the granulation tissue subsides. In addition, the patients must be advised about proper nail trimming.

Since 1993, we have successfully treated 62 patients (age, 15 months to 83 years) including patients with diabetes mellitus, AIDS, leukemia, chemotherapy, drug-induced immunodeficiency, and Buerger's disease. So far, no recurrences or complications have occurred.

The nail splinting technique is simple and easy to perform and does not require any special equipment.

In contrast to invasive treatments, our technique does not cause permanent damage to nail matrix or nailfold. After splinting, the patients experience instant relief of pain. Moreover, with the splint in place, patients are immediately able to resume walking.