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Ingrown ToenailAka: Onychocryptosis

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  1. Epidemiology
    1. Unilateral in 80% of cases
    2. Usually affects hallux (great toe)
  2. Risk Factors
    1. Improper nail cutting (nail incurves into nail fold)
    2. Poorly fitting shoes (callus forms in nail fold)
    3. Obesity
    4. Hyperhidrosis
    5. Foot trauma
    6. Altered gait
    7. Congenital disorders
      1. Pachyonychia congenita
      2. Trisomy 13
      3. Unna-Thost Syndrome
    8. Comorbid conditions
      1. Pityriasis
      2. Hyperthyroidism
      3. Diabetes Mellitus (dystrophic nails)
      4. Acromegaly
  3. Stages: Ingrown Toenail
    1. Stage 1 ingrown nail
      1. Erythema, trace edema and pain at lateral nail fold
    2. Stage 2 ingrown nail
      1. Increased pain and discharge from nail edge
      2. Signs of bacterial Paronychia
    3. Stage 3 ingrown nail
      1. Most significant symptoms of ingrown nail
      2. Lateral nail fold hypertrophy and granulation tissue
  4. Management: Antibiotics
    1. Not routinely recommended
    2. Has been used when matrix destruction is performed but without good evidence
    3. Paronychia may be the only indication for systemic antibiotics
  5. Management: Non-surgical (mild cases with minimal pain or erythema)
    1. Warm soapy water soaks for 15-20 minutes nightly and
    2. Raise lateral nail margins
      1. Insert cotton-wisp or dental floss under nail at ingrown Nail Groove edge or
      2. Use intravenous drip tubing as an improvised gutter splint
        1. Split intravenous drip tubing lengthwise, so can be inserted over the nail edge
        2. Tape or glue (cyanoacrylate) in place
        3. Arai (2004) In J Dermatol 43(10):759
    3. Adjunctive
      1. Apply topical antibiotic (bacitacin) and/or Corticosteroid to ingrown margin twice daily
  6. Management: Surgical nail avulsion (moderate to severe pain, inflammation, purulent drainage)
    1. See Toenail Removal
  7. Complications
    1. Bacterial Paronychia
      1. Treat Paronychia with antibiotics if present
  8. Prevention
    1. Trim nail flat (not too short, not rounded, not V-Shaped)
  9. References
    1. Mandracchia (July, 1998) Hospital Medicine, p. 36-43
    2. Peggs in Pfenninger (1994) Procedures, Mosby, p. 28-43
    3. Heidelbaugh (2009) Am Fam Physician 79(4):303
    4. Zuber (2002) Am Fam Physician 65(2):2547

Nails, Ingrown (C0027343)

Definition (MSH)Excessive lateral nail growth into the nail fold. Because the lateral margin of the nail acts as a foreign body, inflammation and granulation may result. It is caused by improperly fitting shoes and by improper trimming of the nail.
ConceptsAcquired Abnormality (T020)
ICD9703.0, 703.0
MSHD009263
EnglishEmbedded toenail, IGTN - Ingrowing toenail, INGROWING NAIL, Ingrowing toenail, INGROWN NAIL, Ingrown Nails, Ingrown toenail, Ingrown toenail -RETIRED-, OC - Onychocryptosis, Onychocryptosis, Onyxis, Unguis aduncus, Unguis incarnatus
Spanishonicocriptosis, onixis, una de dedo del pie encarnada, una encarnada, una encarnada de dedo de pie, una encarnada de dedo de pie - RETIRADO -, unguis aduncus, unguis incarnatus
Parent ConceptsNail Diseases (C0027339), Deformity (C0302142), Nails, Ingrown (C0027343), Disorder of toe (C0555981), Ambiguous concept (C1274012)
SourcesCOSTAR, ICD9CM, MSH, MTH, MTHICD9, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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