Ingrown nail (onychocryptosis)

The medical term for ingrown toenails is onychocryptosis.

Nail growth occurs constantly, throughout a person's life. The growth rate is about 0.1 mm per day, the nail is completely renewed after 100 days.

Causes of ingrowth

The main causes of ingrowth can be improper and too deep pruning of nails or wearing uncomfortable and inappropriate shoes. The free edge of the nail should protrude at least 1 mm. If you cut the nail to zero, then you can leave small invisible spikes on its corners, which will eventually grow into the skin. Uncomfortable and narrow shoes will put pressure on the nail, which will cause it to take the shape of an arch, and painful sensations will appear.

Ingrown nails are more common in adolescents and young adults. At this age, there is increased sweating, as a result of which the nail fold becomes soft.

The course of the disease

At first, the disease signals itself with pain at the point of ingrowth while walking, especially in tight shoes. Then redness and swelling of the nail roller occurs, and as a result, severe inflammation of the nail plate appears.

Relieving inflammation

Soak your foot in your pelvis or bath. This will remove the tumor and sensitivity. Soak for about 15 minutes 3-4 times a day.

Add the English salt (1 cup per basin) to the water. English salt is famous for its ability to relieve pain and swelling. In addition, it softens the nail.

If you don't have English salt, use regular. Salt water will prevent the appearance of bacteria in a sick place.

Gently massage the sore spot. This will help to drink the ingrown nail with water to clean the bacteria and relieve swelling.

Once soaked, the nail softens. Carefully pick up the edge of the nail with a dental thread. Raise the nail so that it does not grow further into the skin^[1].

Treatment

Podology science is about caring for a healthy and problematic foot, it pays special attention to the prevention of foot diseases and the correction of nail problems on the legs.

The nail plate is formed in the germinal zone (matrix) and subsequently moves along the nail bed. When part of the nail plate is removed and the matrix is preserved, the nail will grow again and cause the same problems, and the disease recurs.

Titanium thread

For 2020, the podologist has at his disposal technologies and means to get rid of the problem almost painlessly - by the method of correction, by installing a titanium thread or other corrective systems.

The titanium thread is elastic and durable. With its help, the nail is raised at the side rollers, preventing it from growing and at the same time correcting the shape of the nail bed. It is also worth noting that the correct procedure and the implementation of the specialist's recommendations significantly reduce the number of relapses.

A corrective design is created for each client, or rather for each nail plate, individually. This is an accurate work that requires detailed knowledge of the technology of installation and anatomy of the nail plate, because each person has a different thickness and shape. Therefore, the specialist must take into account many factors (including height, weight, age, occupation and hobbies of the client) and be able to predict the result.

Surgical operations

The most effective and frequently used surgical operations:

• Marginal resection of the nail plate without resection of the paranogenous roller - includes the removal of 1-2 mm of the ingrown edge of the nail plate with the destruction of the sprout zone of the removed fragment to prevent recurrence. Selection operation with a slightly and moderately changed perianth roll without pronounced granulations and "wild meat."

• Marginal resection of the nail plate with resection of the paranogenous roller (operation according to Schmiden, according to Bartlett) - supplemented by one of the options for resection of the paranogenous roller. Shown with a pronounced change in the peronatal roll, abundant granulations and the presence of "wild meat." In this case, the resected peronatal roll is sutured with single-row interrupted sutures. This type of surgery is more traumatic, however, during the operation, the risk of recurrence is significantly reduced.

• Complete removal of the nail plate (Dupuytren surgery) is used less and less due to the high risk of recurrence, high intensity of pain after surgery and low cosmetic effect. Selection operation in severe nail plate damage, for example, in onychomycosis.

• Radio wave and laser methods. They are rarely used in their pure form, but they can complement edge resection. After removing the ingrown part of the nail by the radio wave method, the doctor acts on the fragment of the sprout zone in order to destroy it and prevent recurrence. The surgeon can do the same procedure using a laser.

Radio wave removal

Radio wave removal is a common procedure that is used for the problem of an ingrown nail: edge resection of the nail plate with partial coagulation of the nail plate matrix using the Surgitron radio wave device. A special electrode coagulates the section of the matrix from which the resected part of the nail plate grew. The destruction of the matrix is the key to the fact that the nail will not grow into soft tissues.

Laser removal

Patients who have ingested a nail on their leg or arm are often offered laser treatment - the method is effective and the risk of recurrence is minimal. Laser treatment does not imply a long rehabilitation period, as in surgical intervention, and also eliminates the risk of blood loss.

The intervention does not require much preparation and can be carried out on the day of the consultation.

Surgical correction is performed in several stages:

• local anesthesia is administered;
• the inside of the nail under the nail roller is removed using a carbon dioxide laser;
• the surgeon applies a tampon with a medicinal product and then a sterile dressing on the wound.

Since the laser beam is highly accurate, the surrounding tissues are not damaged and no bleeding occurs during the procedure.

The procedure begins with the application of local anesthesia. For this, the drug is injected directly into the pad of the sore finger and around the nail. Often used anesthetic "Ledocaine."

After the analgesic drug begins to act, the specialist removes part of the affected nail with a laser. Complete removal is often not necessary, since only the part that grows into soft tissues is cut out. The patient does not feel anything.

The laser cleans the cavity from the accumulated pus, and also burns out the nail matrix so that the damaged part does not continue its growth.

After this procedure, the nail is formed in the correct shape, since the influence of the laser is directed not only on the outer part, but also on the inner.

Most often, the operation time using laser equipment does not exceed half an hour. However, duration can increase in particularly difficult cases. A healthy nail plate often has a smaller width, since the removed parts do not regrow.

In some cases, a complete deletion is required. Fortunately, the need for such an operation arises quite rarely. In this case, the laser removes the matrix of the entire nail. The resulting open area is covered with a flap of skin. Unfortunately, in this case, the new nail will never grow.

After the operation, the podologist treats the wound surface with an antiseptic and performs a dressing, which the patient himself removes the next day. If the wound continues to bleed, then it is recommended to treat it twice a day with an antiseptic and apply a gauze bandage. These procedures are recommended to be repeated throughout the week.

Recovery period:

A day after the manipulation, the patient should come to the surgeon for a dressing, where the tampon is removed from the treatment site. To do this, the leg is immersed in warm water, the tampon is soaked and torn off by rapid movement.

Twice a day, the finger should be bandaged with the application of a sterile dressing. Healing takes 7 to 10 days. If inflammation appears in a week, and the wound itself heals poorly, then a course of antibiotics may be prescribed. The full recovery is completed in a month.

A week after surgery, no dressings are required for normal healing. The nail should remain outdoors for normal soft tissue regeneration. At the same time, it is forbidden to use ointments, powders and other preparations for processing, only the use of liquid antiseptic agents is allowed. Complete recovery takes from 4 to 6 weeks, depending on the complexity of the operation and the size of the wound surface.

Notes