Management of ingrown toenails

Patients with an ingrown toenail are frequently encountered in primary care practice. Ingrown toenails are the result of an alteration in the proper fit of the nail plate in the lateral nail groove. The alteration can be caused by such factors as wearing shoes that do not fit properly or an incorrect nail-trimming technique. Conservative approaches, including soaking the foot in warm water, use of topical or oral antibiotics, proper nail-trimming technique and elevation of the corner of the nail, are often used in patients with mild stage 1 disease. Stage 2 disease is characterized by worsening of symptoms, drainage and infection, and can be managed conservatively or surgically. Stage 3 disease is characterized by lateral wall hypertrophy and is best treated with partial nail avulsion, lateral matricectomy and destruction of the lateral wall granulation tissue. Chemical matricectomy with phenol is effective, but electrosurgical matricectomy may offer more controlled tissue destruction and less postoperative drainage. A modern office technique for managing stage 3 ingrown toenails is reviewed.