Toe nail reattachment

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I would like advice regarding treatment and success rates for partially separated nail plates from the nail bed due from either fungus or repetitive trauma.
Even after lengthly fugal treatment and removal of the repetitive trauma I have limited success. Any tricks to convince the nail bed to take the nail plate back to the hyponychium.

thanks

A. Irvine

 

In my experience I have found that it very much relates to the degree of disruption and distortion of the nail bed. If Mt Vesuvius is present on the bed, no amount of coercing will allow the nail to lie happily. But if anyone does have advice for these digits, I would also be appreciative.
Tree :santa2:

 

I'm no nail guru, but on occasion when I treat these I need to remind myself that nails are a dead structure and do not reverse themselves. All you can hope for is that any new growth is normal.
Any repetitive trauma that you feel is responsible for nail changes must be eliminated for at least 10 months before a patient sees any large percentage of normal nail plate.

When I have a patient complaining of pain associated with a dystrophic nail and a long, hyperextended hallux I usually don't even attempt to get a normal nail, just remove it permanently. If it doesn't hurt then leave it.

Steve

 

Nailplate and sterile matrix grow together. Try taping the nailplate down so that it cannot lift. We also need to ensure that pt is not soaking or using oils/detergent shower gels that could threaten the bond. Nail biomechanics (H limitus/H rigidus/hyperextended distal phalanx) can affect matrix vascularity - defend/offload. Beware the short shoe/low toe-box.