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ReProspective student here!

Patient presents with ingrown toenail. Nail is short because they have possibly tried
to remove spike etc. If they present to me in clnic what do I do. Cant remove corner as nail so short already. Is it just a blacks file I use to locate the position of the spike etc to get it forward and then use nail clippers.

Anyone???

Thanks

 

Identify the cause and reason for the issue in the first place as this will effect your management. However by the sounds of it Local anesthetic + removal of offending nail edge = happy patient :) If the issue is nail position related (i.e. involution) then the addition of phenol to prevent recurrence may be required. Of course it goes without saying appropriate discussion and education is always a MUST!

 

Yes, music that is what I would do. If you in private practice, tell them to make another appointment when toenail pain reoffends, that way you can do a better job of helping the patient. Footwear is really important. Tell pt to use nail brush to remove debris and to use lots of emollient. Once the toenail has reoffended with pain the abovementioned procedueres will make it easier to cut toenail back further, and to round off with blacks file and should last longer, inbetween appointments. If you in NHS well....apply the above but you will have to reschedule the appointment that fits the NHS diary.

Paul, we were taught that phenol must be used when undertaking all ingrown toenail removal procedures. This ensures that 99.9% of the time it will prevent toenail from growing back again.

 

I don't think the recurrence rate in the literature is 0.1% - its more like somewhere between 8% and 25% depending on which research you read.

Phenol doesnt always have to be used, depending on nail position, sometimes its just quicker and easier to anaesthetise the digit and surgically remove the whole side of the offending nail. Usually it simply grows back over 6+ months and if the primary cause is not there then there is no issue again.

 

Re/ Paul's observations and advice above - agreed.

 

When we do nail surgery, we use either Phenol or Radiolase in clinic depending on whether its a regrowth or infection etc etc, we've found that they are both around 94%/95% successful in killing the nail bed. If the patient has regrown after using phenol to ablate, then we will consider using radiolase and vice versa. If the patient however has an infection in the sulcus, we will 99% of the time use Phenol as it is far more effective at killing off the infection & ablating at the same time than Radiolase is.