It is 4 a.m. You pick up a chart. Toe pain.
Thinking this could be an easy injury, you walk over to the patient, only to discover: bilateral ingrown toenails. Your heart sinks. In your head, you are thinking: Lateral nail resection? Nail removal? This could take a while.
Is there a less invasive method for treating an ingrown toenail?
Trick of the Trade: Toenail splinting
The referenced article describes splinting the toenail, essentially lifting the offending edge of the toenail so subsequent growth does not push into the tissue.
- Anesthetize the toe either by topical anesthetic or by nerve blocks (not always necessary for mild cases).
- Excise nail sulcus using the tip of a curved hemostat to provide space. See photo above.
- Roll a 2-3 cm wisp of cotton saturated with alcohol to form a cylinder.
- Tuck the cotton into the nail sulcus, gently tucking it under the lateral free edge of the nail. This will keep the nail lifted during subsequent growth. Can also use a curved hemostat for this step.
- Patients should keep splints on for up to 3 months until the offending corner of nail grows past the distal edge of the lateral nail fold. Do not trim nails. Patients can repeat this process if the cotton falls out.
Variations
Steri-strips or dental floss can also be used.
What I found
This works great. Most times patients do not need nerve blocks and tolerate it well. I know colleagues who use this technique on their own toes!
Reference
Pottie K, Dempsey M, & Czarnowski C (2003). Practice tips. Toenail splinting. Canadian family physician Medecin de famille canadien, 49, 1451-3 PMID: 14649982 Free PDF download of article
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