Clinical Review

The management of ingrowing toenails

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2089 (Published 03 April 2012) Cite this as: BMJ 2012;344:e2089
  1. Derek H Park, specialist registrar in trauma and orthopaedics,
  2. Dishan Singh, consultant orthopaedic surgeon, clinical lead
  1. 1Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK
  1. Correspondence to: D H Park derekpark{at}doctors.net.uk
  • Accepted 14 February 2012

Summary points

  • Ingrowing toenails are common, cause serious disability, and affect mainly young men

  • There is a spectrum to the clinical presentation with pain progressing to infection, hypergranulation, and finally chronic infection

  • Ingrowing toenails can occur in normal or abnormally shaped nails

  • Cases in abnormally shaped nails are more difficult to manage conservatively and usually require surgery

  • Symptoms are less likely to recur after partial nail avulsion and segmental phenol ablation than after simple nail avulsion or wedge excisions alone

Sources and selection criteria

We searched Medline (PubMed), the Cochrane Database of Systematic Reviews, Cochrane central register of controlled trials, and CINAHL using the search terms “ingrowing toenails”, “ingrown toenails”, and “onychocryptosis”. We identified additional literature from the references of identified papers. In addition, we consulted standard orthopaedic textbooks on the subject and reviewed the main references quoted.

Ingrowing toenails are a common condition that causes pain and disability in the foot. The condition occurs when the nail plate traumatises the nail fold, giving rise to pain, inflammation, or infection (or a combination thereof). It commonly occurs in the great toe but can also affect the lesser toes. Patients with ingrowing toenails are usually male, between the ages of 15 and 40 years; they are often encountered in general practice, with an estimated 10 000 new cases presenting in the United Kingdom each year.1 The condition is managed by a wide variety of healthcare professionals including general practitioners, podiatrists, dermatologists, general surgeons, and orthopaedic surgeons. The surgical treatments for ingrowing toenails include procedures on the nail plate, the nail bed (germinal matrix), and the surrounding soft tissues. Historically, a recurrence rate of 13-50% has been reported after surgical treatment,2 although more recent papers have reported recurrence rates of less than 5%, particularly with the use of wedge resection of the nail and phenol ablation …

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