Stephen K. Stacey, DO A practical guide to the care Peak Vista Family Medicine Residency Program, Colorado of ingrown toenails Springs, Colo
[email protected] The author reported no Choose either a conservative or surgical treatment potential conflict of interest approach based on severity. The Vandenbos procedure, relevant to this article. described here, is an effective surgical option. CASE u PRACTICE A 22-year-old active-duty man presented with left hallux pain, RECOMMENDATIONS which he had experienced for several years due to an “ingrown ❯ Consider conservative toenail.” During the 3 to 4 months prior to presentation, his therapy as first-line pain had progressed to the point that he had difficulty with treatment for patients with mild to moderate weight-bearing activities. Several weeks prior to evaluation, he cases of onychocryptosis. A tried removing a portion of the nail himself with nail clippers and a pocket knife, but the symptoms persisted. ❯ Surgical interventions A skin exam revealed inflamed hypertrophic skin on the are more effective than nonsurgical interventions medial and lateral border of the toenail without exudate in preventing the recurrence (FIGURE 1A). The patient was given a diagnosis of recurrent ony- of ingrown toenails. A chocryptosis without paronychia. He reported having a similar occurrence 1 to 2 years earlier, which had been treated by his ❯ Offer the Vandenbos primary care physician via total nail avulsion. procedure to patients with severe or refractory How would you proceed with his care? onychocryptosis because it is definitive and has a good nychocryptosis, also known as an ingrown toenail, is a aesthetic outcome.