The management of ingrowing toenails.

Ingrowing toenails are a common condition that causes pain and disability in the foot. The condition occurs when the nail plate traumatises the nail fold, giving rise to pain, inflammation, or infection (or a combination thereof). It commonly occurs in the great toe but can also affect the lesser toes. Patients with ingrowing toenails are usually male, between the ages of 15 and 40 years; they are often encountered in general practice, with an estimated 10 000 new cases presenting in the United Kingdom each year.The condition is managed by awide variety of healthcare professionals including general practitioners, podiatrists, dermatologists, general surgeons, and orthopaedic surgeons. The surgical treatments for ingrowing toenails include procedures on the nail plate, the nail bed (germinal matrix), and the surrounding soft tissues. Historically, a recurrence rate of 13-50% has been reported after surgical treatment, although more recent papers have reported recurrence rates of less than 5%, particularly with the use of wedge resection of the nail and phenol ablation of the nail matrix. 4 ACochrane review of nine randomised clinical trials of surgical treatments concluded that simple nail avulsion combined with phenol ablation was most effective in reducing symptomatic recurrence. It is important to recognise, however, that the presentation and disease process of ingrowing toenails covers a wide spectrum, and that management options will depend on the stage at which a patient presents. We review the management of ingrowing toenails, focusing on the effectiveness of the procedures most commonly used. Anatomy of the nail and surrounding area