​Surgery - Ingrowing Toenail

​Surgery - Ingrowing Toenail
Introduction 
An infection and inflammation are brought on by the lateral edge of a toenail growing into the soft tissue of the nail fold. Officially, it's called onychocryptosis.


Etiology 
Along its edge, the toenail penetrates and develops into the skin. It may cause a bacterial or fungal infection on top of a foreign body reaction. Exuberant granulation tissue production can be the outcome of tissue healing.

Risk Factors 

inadequately sized toenails, toe damage, ill cleanliness, and ill-fitting shoes—particularly those with tapering fronts.

Epidemiology 
Typical. more typical in teenagers and young adults.
H HISTORY
Pain in the swollen toe and around the edges of the toenail. Ask about diabetes.

Examination 

Warmth, discomfort, erythema, and oedema, usually on the big toe. Compared to the medial side of the toenail, the lateral side is more prone to be impacted.


Investigational studies

Usually not required.
Pus swab: Respect and tact if afflicted.
Toe radiograph: For osteomyelitis in diabetics and cases of severe infection.

Management 
Medical: Podiatry care and basic analgesia for pain. If the foot appears early, it should be washed and dried carefully on a regular basis. Tips for keeping toenails trimmed transversely, as well as instructions on donning fresh socks and roomy shoes. If infected, antibiotics could be required (after incision and drainage if pus is present), particularly in diabetics.


Surgery: In cases that are severe or recurring. Local anesthesia with a ring-block.
If there is a localized pus collection, make an incision and drain the pus.
Avulsion of the nail: The toenail is cut off without damaging the nail bed. The likelihood of recurrence is about 50%.
Wedgeresection: Using phenol to kill the nail bed, the lateral portion of the nail that is ingrowing alongside the nail bed (about 25% of the nail) is excised. By doing this, the pressure on the toe's sides is released and the nail's regeneration into the skin is stopped.
Under Zadik's technique, the entire nail is extracted, and the nail bed is destroyed.

Complications 
Permanent nail loss, malformation of the nail bed and surrounding toe, secondary infection of the nail and toe (typically fungal).

Prognosis 
generally favorable if caught early. Up to 30% of cases recur. Diabetes has a greater morbidity rate and can result in toe (or perhaps limb) loss.