Treating Ingrown Toenails

What is conservative care of an ingrown toenail include?

1. basic foot care 2. footwear advice 3. partial or full removal

What are the 2 contraindications for toe nail removal?

1. bleeding diathesis (tendency to bleed or bruise easily) 2. allergy to local anesthesia

Potential complications of toe nail removal include? (2)

1. infection (prevent by abx and frequent soaks) 2. regrowth of nail bed and return of symptoms (w or w/out cauterization this can occur)

What are the indication of toe nail removal? (4)

1. onychocryptosis (ingrown nail) 2. Onychomycosis (fungal infection of the nail) 3. chronic, recurrent paronchia (inflamm of the nail fold) 4. Onychgryposis (deformed, curved nail)

How do you educate the patient on prevention of another ingrown toe-nail? (3 things)

1. wear low heeled shoes with room for forefoot and toes 2. Not to trim nails too short 3. trim nails in a flat straight across fashion

How long after toe-nail removal should the patient change the dressing? How many times should the patient soak their toe and in what?

24 hours soak toe 2x per day for several days in warm water

After a toe-nail removal how long should the patient keep their toe elevated? What pain medication is used for pain relief prior to a toe-nail removal?

24-36 hours with gradual return to ambulation OTC analgesics

What is the definitive treatment for an ingrown toe-nail when there is painful swelling, inflammation and infection?

Partial or total removal of the nail

Do you place antibiotic ointment on the nail bed and a nonadherent gauze to the toe after toe nail removal?

YES

If permanent removal of the nail is desired to prevent recurrent problems the matrix of the nail bed must be ________ With what?

ablated 88% phenol solution applied with cotton-tipped applicator for 3 minutes **this lowers the rate of reoccurrence of ingrown toenail

First treatment of ingrown toenails in patients with DM or PVD is ____________ if operative treatment is still indicated then ... DM and PVD patients are considered on a

conservative then refer to specialist case-by-case basis ("relative contraindication")

What nerves supply the great toe? How many nerves total do you anesthetize in toe nail removal prior to the procedure?

digital nerves that have an extensor and plantar branch on both the medial and lateral aspects of the toe 4 nerves total that are anesthetized

If the entire nail is to be removed cutting the nail in half in a lengthwise manner causes

easier removal

Nails are derived by __________ of cells from the ______ _______

kertanization of cells from the nail matrix

What is a effective way to prevent reoccurrence/regrowth of an ingrown toe-nail?

nail avulsion (removal) with phenol cauterization/ablation (vs. just removing the nail)

nail matrix is the same as nail _______ and is located at what end of the nail plate (actual nail)?

nail bed located at the proximal end of the nail plate

When using phenol solution to prevent reoccurrence of ingrown toe nails what must you be careful of?

not to expose surrounding tissue to the phenol solution

Pregnant women should not receive _______ ________ for the treatment of ingrown toenails.

phenol ablation/cauterization (used to prevent regrowth)

During toe nail removal what do you apply to the nail bed/matrix to control bleeding?

silver nitrate