Introduction primary fault is the nail itself or

Introduction

Onychocryptosis also known as ingrown toenail, or
unguis incarnatus is a common and painful nail
disease. Ingrown toenails are common worldwide and
diverse treatment options exist7.
It is the most common in teenagers and young adults during the second and third
decades of their life.1
Many anatomic and behavioural factors are thought to contribute to
ingrown toenails, such as improper trimming, repetitive or inadvertent trauma,
genetic predisposition, hyperhidrosis, and poor foot hygiene. 3
The commonest symptom is pain in the affected nail which, if left untreated
leads to infection, discharge and difficulty in walking, greatly hampering the
quality of life of the individual. Diagnosis is apparent and several treatment
approaches exist, ranging from a conservative medical approach to extensive
surgical treatment options. The therapeutic approach chosen is dictated by the
severity and stage of the ingrown toe nail.1

We Will Write a Custom Essay Specifically
For You For Only $13.90/page!


order now

     Various
theories have been proposed to explain the aetiology of the ingrown toenail and
they can be broadly classified according to whether the primary fault is the
nail itself or the soft tissues at the side of the nail. One theory
is that the nail is not the real culprit, and it is actually the excess skin
surrounding the nail which is the real problem. The persons who develop
this condition have an unusually wide area of tissue medial and lateral to the
nail and that with weight bearing, this tissue tends to bulge up around the
nail, leading to pressure necrosis.  A prospective study by
Pearson and colleagues failed to demonstrate any abnormality of the nail
in patients with symptomatic ingrown toenails, and suggested that treatment
should not be based on the correction of a non-existent nail deformity.
Although it is still believed that the real defect lies in the nail, the
controversy of whether there is a nail plate abnormality or overgrown nail
folds still exists. 1

       Although an ingrown toenail can affect
any age group, teenagers are usually most prone to the development of this
abnormality. In teenagers, increased perspiration causing the nail fold to
become soft and participation in sports result in the production of nail
spicules, which can pierce the lateral skin fold of the nail apparatus. In
older persons, spicule formation can be caused by reduced ability to care for
their nails secondary to reduced mobility or impaired vision. In addition, the
natural aging process causes toenails to thicken, making them more difficult to
cut and more inclined to exert pressure on the lateral skin at the sides of the
nail plate, often becoming ingrown, painful, and infected(2)

Method and Materials

     Patients,
aged between 12 and 60 years with a clinical diagnosis of an ingrown toenail
were included. The affected toe and foot were evaluated at baseline for the
stage and type of ingrown toenail and the condition of the nail structures
using the following criteria: Stage 1 was defined as the presence of only mild
erythema or edema, with pain on applying pressure, Stage 2 as significant
erythema or edema with sero-purulent drainage from the affected nail fold and
Stage 3 as significant drainage, formation of granulation and lateral wall
hypertrophy. At baseline, a potassium hydroxide (KOH) mount of the nail
clipping was examined to rule out fungal infection for all patients with nail
thickening, distal onycholysis, or subungual debris.5

     The
patient’s age, sex, the types of their footwear and the places which are
frequently visited by them were recorded. This was done to help analyse the
cause of their condition. The records taken ranged from fresh to old cases. The
treatment they sought (if any) was also recorded. Based on these records, the
causes for the condition were also deduced.

           Ingrown toenails are not difficult
to diagnose. Usually self-diagnosis can identify the condition. Since this
condition is so easy to diagnose, many patients try to cure it themselves. This
complicates the condition as the severity of the disorder cannot be
self-diagnosed. It is best for the patients to consult a specialist before
trying to treat it themselves.

Result

The data of all
the cases observed are given below

Gender

Age

Preferred type of footwear

Places visited on a daily basis

Deduced cause of condition

Severity of the condition

Treatment advised (By a foot specialist)

Male

17

Sandals

Railway
Station

Trauma

Stage
1

Conservative
Therapy

Male

43

Shoes

Bus

Trauma
and Sweating

Stage
1

Thorough
cleaning of the toe

Female

17

Sandals

Muddy
Streets

Bacterial
Infection

Stage
1

Cleaning
of the toe

Male

20

Shoes

Football
Ground

Poorly
fitted shoes, Poor feet hygiene and Sweating

Stage
3

Unilateral
Matricectomy

Female

13

Slippers

Trauma

Stage
2

Dental
Floss Technique

Female

16

Shoes

College

Poorly
fitting shoes

Stage
1

Change
of shoe; Conservative Therapy

Female

56

Slippers

College

Poor
Feet Hygiene

Stage
1

Thorough
cleaning

Male

15

Shoes

Badminton
Court

Poorly
fitting shoes, Sweating, Bacterial Infection.

Stage
3

Chemical
Bilateral Matricectomy, Change in shoe

Male

60

Sandals

Bacterial
Infection

Stage
2

Conservative
Therapy

Male

21

Shoes

Hospital

Trauma

Stage
2

Conservative
Therapy

Male

14

Sandals

Factory

Poorly
Fitting shoes, Trauma

Stage
1

Conservative
Therapy

Female

13

Sandals

School

Trauma

Stage
2

Gutter
Splint Technique

Male

45

Shoes

Bus

Trauma,
Sweating

Stage
1

Conservative
Therapy

Female

26

Shoes

Railway
Station

Poorly
fitting shoes

Stage
1

Change
in shoe

Female

38

Barefoot

Trauma,
Mild Bacterial Infection

Stage
2

Conservative
Therapy first time. On reoccurrence of condition, Unilateral Matricectomy

Male

15

Shoes

School

Poorly
Fitting Shoes, Extremely poor feet hygiene

Stage
3

Bilateral
Partial Matricectomy

Male

15

Shoes

Cricket
Ground

Sweating,
Bacterial Infection

Stage
2

Gutter
Splint

Female

60

Shoes

Railway
Station

Trauma,
Sweating

Stage
1

Conservative
Technique

Female

46

Sandals

School

Stage
1

Dental
Floss Technique

Male

23

Shoes

College

Poor
feet hygiene, Bacterial Infection

Stage
2

Conservative
Technique

Male

16

Shoes

School

Trauma

Stage
1

Conservative
Technique

Male

14

Shoes

School

Poor
Feet Hygiene

Stage
2

Bilateral
Partial Matricectomy via electrocautery

Female

16

Shoes

College

Sweating,
Bacterial Infection

Stage
2

Dental
Floss Technique

Male

16

Shoes

Tennis
Court

Trauma

Stage
3

Dental
Floss Technique

Male

27

Sandals

Bacterial Infection

Stage 1

Conservative Technique

Female

15

Shoes

Badminton Court

Trauma, Poorly Fitting Shoes

Stage 1

Conservative Technique

 The data confirmed that the most common age
group who are affected by onychocryptosis are teenagers. Another thing that
came to light was that the most common cause of ingrown toenail was trauma to
any side of the nail. This backs up the hypothesis that teenagers are more
prone to ingrown toenail rather than adults because teenagers are more agile,
flexible and energetic than adults. So it is more likely for them to suffer
trauma in their foot.

    Another thing that was found out was that
the most common treatment for Stage 1 and Stage 2 onychocryptosis is
Conservative Therapy. This is so because most of the time, Stage 1 and Stage 2
ingrown toenails do not show complexities that requires surgical corrections.
One of the techniques in conservative therapy includes soaking the affected toe and foot for 10 to
20 minutes in warm, soapy water. After each soak, expert recommendation is to
apply a topical antibiotic ointment (e.g., polymyxin/neomycin Neosporin) or a
mid- to high-potency steroid cream or ointment to the affected area several
times daily for a few days until resolution 3. The
most popular conservative therapies include warm water soaks, topical or oral
antibiotic therapy, proper nail trimming, and elevation of the corner of the
nail with a cotton wick. 17 The second most common reason
for occurrence of ingrown toenail is wrong size of footwear. People often
compromise on their footwear when it comes to compatibility. This puts a lot of
pressure on the toenails which often leads to a wound in the skin below the
nail as it was already under pressure. The data also shows that in some cases,
no treatment was done. In these cases, the patient let the wound heal itself
without any interference from the outside.

     One other thing to be seen was that people
who go to places which has a dusty environment or to places where physical
activity is done (eg. Places like the football ground and the badminton court)
are more prone to ingrown toenails via bacterial infection or excess sweating
than other people if they don’t take care of their feet. 

x

Hi!
I'm Alejandro!

Would you like to get a custom essay? How about receiving a customized one?

Check it out