Management of ingrown toenail

Ingrown toenail is a common podiatric condition characterized by the penetration of the nail edge into the adjacent periungual soft tissue, most frequently affecting the great toe. It typically presents with pain, erythema, edema, and, in advanced cases, infection. Although it can occur at any age, it is more prevalent among young adult males. The etiopathogenesis involves improper nail trimming, the use of tight or pointed footwear, foot deformities, trauma, and excessive sweating. Additionally, hereditary factors and abnormal nail morphology may contribute to its development.

Ingrown toenails are clinically classified into three stages according to the Heifetz classification. The management approach is determined according to the clinical stage of the disease. Generally, conservative management is indicated for early-stage cases and aims to relieve symptoms and prevent progression without surgical intervention. General measures include appropriate footwear, correct nail trimming (cutting nails straight across without rounding the corners), and maintaining proper foot hygiene. Warm saline or antiseptic soaks several times daily may reduce inflammation. Placement of a small cotton wick, gauze, or plastic splint under the nail edge can help separate the nail from the soft tissue. Topical or systemic antibiotics may be required in the presence of infection. For recurrent and severe cases, treatment options include chemical matricectomy, surgery, electrocautery, cryosurgery, and CO2 laser matricectomy. Chemical matricectomy involves the use of active agents such as phenol, sodium hydroxide (NaOH), trichloroacetic acid (TCA), or silver nitrate. The Winograd technique is the one of the most performed technique in surgical procedure. Total nail avulsion is rarely indicated and should be limited to cases involving extensive nail deformity or widespread infection. Postoperative care includes aseptic dressing, regular wound monitoring, and adequate pain control. Complications may include infection, bleeding, necrosis, nail deformity, and recurrence. Performing surgical interventions under sterile conditions by experienced practitioners significantly reduces these risks. Patients should be advised to elevate the affected foot, wear loose footwear, and maintain proper nail and foot hygiene during recovery.

In conclusion, the management of ingrown toenail requires a multidisciplinary approach involving accurate staging, appropriate treatment selection, and patient education. Early diagnosis and evidence-based treatment protocols play a crucial role in improving patient outcomes and quality of life.

He is  Y.Doruk Bilgili. he completed his medical education at Demiroğlu Bilim University between 2009 and 2015. He completed my residency in pediatric surgery at Zonguldak Bulent Ecevit University between 2016 and 2022. He worked at Siverek State Hospital and Bandirma Training and Research Hospital between 2022 and 2024. He has been working as Head of Pediatric Surgery Department at Bandirma Onyedi Eylul University since April 2024. He is doing research on circumcision, perioperative anxiety and appendicitis.