Onychocryptosis
Etiology
Improper nail trimming
Tight shoes & socks
Poor hygiene
Repetitive trauma to distal toe
Curved nail bed in elderly
Stages
1. Inflammation
- painful irritation about embedded nail plate in lateral groove
2. Infection
- overt infection with granuloma & discharge
- starts as serous discharge then purulent
3. Granulation
- stage 1 & 2 + chronic changes
- hypertrophy of lateral wall
- growth of epithelium over chronic granulation tissue
Management
Stage 1
Warm saline soaks x2 /day
Lift nail corner
Cleaning of lateral groove
Stage 2
Oral antibiotics then non-operative
Partial nail ablation / wedge resection if fails
Stage 3
Partial nail ablation / wedge resection
Operative management
Wedge resection
Technique
- remove lateral part of nail
- partial ablation of nail matrix
- debulk tissue in lateral fold
Zadek's
Technique
- removal of nail plate
- removal of entire germinal nail matrix proximal to lunule
Terminal Symes procedure
Technique
- amputation of the distal half of the distal phalanx
- toe end appears bulbous