Intended for healthcare professionals

Rapid response to:

Clinical Review

The management of ingrowing toenails

BMJ 2012; 344 doi: (Published 03 April 2012) Cite this as: BMJ 2012;344:e2089

Rapid Response:

Re: The management of ingrowing toenails

Responding to the article 'The Management of Ingrowing Toenails'
(BMJ 2010;344:e2089), I have found one useful addition to the conservative management of early disease is to ask the patient to use a toothbrush and brush gently up and down in the nail side gutter. At first the toe is very tender so only a gentle touch is possible but, as the inflammation settles, the brushing can be increased. This is also effective after an excision of a wedge of nail only (useful because it does not damage the nail bed and is less painful post-operatively), as the inflammation heals.

I also add that I have never seen a so-called 'nail spike'. It seems more sensible to consider this condition begins as a simple paronychia (bacterial or fungal) causing oedema of the tissue lateral to the nail which then 'grows over' the nail rather than the nail 'growing in'. A viscious circle is set up with increasing pressure and obstruction on the nail gutter. Hence the effectiveness of the brushing treatment I describe.

Competing interests: No competing interests

16 April 2012
Marcus H Ornstein
Consultant General Surgeon
Homerton University Hospital NHS Foundation Trustt
Homerton Row, London E9 6SR