Risk factors for poorly controlled and recurrence-prone ingrown toenails treated with nail braces: A retrospective observational study of 238 cases

Background: Nail braces are reportedly effective for treating both acute inflamed and chronic dystrophic type ingrown toenails. Aims: In this study, risk factors for poorly controlled and recurrence-prone ingrown toenails treated with nail braces were identified. Methods: We performed a retrospective study on patients with ingrown toenails between June 1, 2015, and May 31, 2018. The last follow-up date was January 31, 2019. Multivariate logistic regression was performed to evaluate the possible factors associated with poorly controlled status (ongoing paronychia during treatment) and recurrence. Results: There were 120 (244 sides) and 118 patients (167 sides) with chronic dystrophic and acute inflamed type ingrown toenails, respectively. The mean treatment duration and follow-up period were 161.2 ± 98.3 days and 432.7 ± 320.9 days, respectively. Poor control and recurrence were seen in 7.3% (17/232) and 12.2% (27/221) of the patients, respectively. In the multivariate analysis, acute inflamed ingrown toenails, previous nail avulsion, proximal nail fold hypertrophy and more than one affected side remained significantly associated with poorly controlled ingrown toenails. Foot bone deformity was significantly associated with recurrence. Limitations: This study was a retrospective study so that confounding factors such as comorbidities, body mass index, accompanying nail changes and lifestyle could not be evaluated. Conclusion: Several risk factors related to poor control and recurrence were identified. Patients could therefore benefit from more suitable treatment plans with reasonable expectation.

Abordagem cirúrgica de retroníquia refratária a tratamentos clínicos / Surgical approach to retronychia refractory to clinical treatments

Retroníquia é uma onicopatia inflamatória caracterizada pelo crescimento desordenado e empilhamento de lâminas ungueais, associados ao desequilíbrio na produção matricial de placas, que costumam se sobrepor. Este quadro pode estar associado a trauma, evoluindo com reação inflamatória junto à dobra ungueal proximal e formação de tecido de granulação. Relatamos o caso de um paciente com retroníquia no hálux esquerdo, submetido a tratamento cirúrgico após falhas de respostas terapêuticas a tratamentos clínicos prévios. A abordagem cirúrgica levou à avulsão das lâminas ungueais sobrepostas e à exérese de volumosos tecidos de granulação, com adequada evolução no pós-operatório

Retronychia is an inflammatory onychopathy characterized by the disordered growth and stacking of nail plates, associated with an imbalance in the matrix production of plaques, which tend to overlap. This condition may be associated with trauma, evolving with an inflammatory reaction along the proximal nail fold and granulation tissue formation. We report the case of a patient with retronychia in the left hallux, submitted to surgical treatment after failure of therapeutic responses with previous clinical treatments. The surgical approach led to the avulsion of the overlapping nail plates and the excision of voluminous granulation tissues, achieving adequate postoperative evolution.

Unha em arpão: uma forma incomum de onicocriptose / Harpoon nail: an unusual form of onychocryptosis

A onicocriptose é uma doença ungueal frequente, que afeta mais comumente os pododáctilos e apresenta algumas variantes, dentre as quais a pouco conhecida "unha em arpão". O diagnóstico costuma ser clínico, e o tratamento cirúrgico emprega diferentes técnicas descritas na literatura. Relatamos o caso de um paciente masculino, 25 anos, com unha em arpão no hálux esquerdo, e a técnica cirúrgica utilizada para o tratamento com excelente resultado

Onychocryptosis is a frequent nail disease, which most commonly affects the toes. It has some variants, including the little known "Harpoon Nail". The diagnosis is usually clinical, and the treatment is surgical, with different techniques described in the literature. We report the case of a 25-year-old man with a harpoon nail on the left hallux and the surgical method used for treatment with excellent results

Management of Ingrown Nails

Abstract@#Ingrown nails mainly affect the great toes, much less frequently lesser toes and rarely fingers. There are many speculations as to their etiology and pathogenesis; however, at the end, there is almost always a imbalance between too wide the nail plate and too narrow the (distal) nail bed. Ingrown nails occur at all age periods, from newborns to the over-100s though with different frequency, clinical characteristics, and management options. In recent years, conservative treatment options – taping, packing, gutter, braces, and many more - were developed avoiding the often disfiguring results of inadequate surgery. However, they require consistent and long-term therapy. Surgery is either aimed at narrowing the wide nail plate or reducing the hypertrophic lateral nail folds. The number of operation methods is vast; already 150 ago, more 75 different surgical techniques had been known, and there is virtually a new one published every week. Despite ingrown nails being a matter of concern for medical doctors since antique, new aspects continue to be detected, such as retronychia. Further, it was found that orthopedic foot abnormalities are very frequently seen in association with ingrown nails. Their treatment is often necessary to prevent recurrences.

Nail removal in combination with periungual dermis-fat flap tamponade for the treatment of bilateral severe curved ingrown nails in seven patients / 中华皮肤科杂志

Objective:To investigate clinical efficacy of nail removal in combination with periungual dermis-fat flap tamponade in the treatment of bilateral severe curved ingrown nails.Methods:A retrospective analysis was conducted on clinical data collected from 7 patients with bilateral severe curved ingrown nails visiting the hospital between January 2018 and January 2020. There were 3 males and 4 females, aged 25-49 years (average: 35 years) . All patients were treated with nail removal in combination with periungual dermis-fat flap tamponade at outpatient clinics.Results:All the 7 patients experienced primary healing of incisions without infections, and achieved pain relief 1-2 weeks after surgery. During the follow-up of 12 to 24 months, new nail plates grew back without curling deformity, no erythematous swelling occurred in the nail grooves, and no recurrence of paronychia was observed. All patients were satisfied with the clinical efficacy.Conclusion:Nail removal in combination with periungual dermis-fat flap tamponade is effective for the treatment of bilateral severe curved ingrown nails.

Six steps to standardize the surgical approach for ingrown toenail

Abstract Background: Dermatologists don't have a good knowledge of the surgical treatment for ingrown toenails and there is no consensus on which is the best approach. Objective: To develop an easy and effective surgical approach to solve the problem of ingrown toenails. Methods: We identified 67 patients with ingrown toenails in varying degrees of severity which were treated with the standardized approach. Results: All the patients had a completely recovery from the disease and none complained about the cosmetic result. Study limitations: The number of cases is limited. Conclusion: The standardized surgical approach is easily learned and very effective. The recurrence rate is lower than with other treatments.

Tampon tamponade combined with wedge resection of the nail folds for the treatment of ingrown toenail-induced paronychia: a clinical observation / 中华皮肤科杂志

Objective:To evaluate clinical effect of tampon tamponade combined with wedge resection of the nail folds in the treatment of ingrown toenail-induced paronychia.Methods:A total of 96 patients with ingrown toenail-induced paronychia were collected from Department of Emergency Medicine, General Hospital of Ningxia Medical University between August 2017 and April 2019, and randomly and equally divided into 2 groups by using a random number table: control group treated surgically with the Winograd method, and treatment group treated with tampon tamponade combined with wedge resection of the nail folds. All the patients were followed up for 6 - 23 months after surgery.Results:Six months after operation, 47 (97.92%) and 41 (85.42%) cases were cured in the treatment group and control group respectively, and the cure rate significantly differed between the 2 groups ( χ2 = 4.909, P < 0.05) . The visual analogue scale scores for pain were significantly lower in the treatment group than in the control group on day 3 and 1 month after operation (both P < 0.05) . The postoperative recurrence rate and infection rate were 0 and 2.08% in the treatment group respectively, which were significantly lower than those in the control group (6.25%, 12.5%, respectively, both P < 0.05) . Conclusion:Tampon tamponade combined with wedge resection of the nail folds is effective for the treatment of ingrown toenail-induced paronychia with a simple operative procedure and a low postoperative recurrence rate, and is worthy of clinical promotion.

Short-Term Surgical Outcome of the Partial Nail Extraction in Ingrown Nail of Military Trainee: Is Matrixectomy Necessary? / 대한족부족관절학회지

PURPOSE: An ingrown nail is common in military trainees who are exposed to highly demanding activities. Although the matrixectomy procedure has been the main treatment modality, several drawbacks may follow after the procedure, such as infection, periostitis, and continued pain that causes a delayed return to duty. This study examined the outcomes of a simple partial nail extraction with the hypothesis that this procedure may bring an earlier return to duty, lower the perioperative complications, and produce a comparable recurrence rate. MATERIALS AND METHODS: The medical records of patients who had surgical treatment for an ingrown nail in the authors' institution between April 2016 and December 2017 were reviewed retrospectively. Under the inclusion and exclusion criteria, 28 patients with a simple partial nail extraction (group A) and 29 patients with a partial nail extraction with matrixectomy (group B) were investigated. As the clinical outcome, the visual analogue scale (VAS) and satisfaction score, time to return to duty, complications, and recurrence rate were checked and compared between the groups. RESULTS: The VAS scores of group B were significantly higher during the first (p<0.001) and second (p=0.026) follow-up week than group A. The time to return to duty was shorter in group A (7.8 days) than group B (10.1 days), and this difference was significant (p<0.001). Group B had five patients with complications, whereas group A had none (p=0.028). No differences in the recurrence rate (p=0.197) and patient satisfaction (p=0.764) were found between the groups. CONCLUSION: In this study, simple partial nail extraction in military trainees resulted in lower postoperative pain, lower complication rates, and earlier return to duty than the procedure with matrixectomy. Military trainees are temporarily exposed to highly demanding activities. Thus, a satisfactory outcome would be expected with simple partial nail extraction without performing a radical procedure, such as a matrixectomy.

Ingrowing toenails in children and adolescents: is nail avulsion superior to nonoperative treatment?

INTRODUCTION@#Ingrowing toenail (IGTN) or onychocryptosis is not uncommon in children and adolescents. However, there is a dearth of evidence in the literature on the management of IGTN in this age group. This study aimed to compare the results of nonoperative treatment for IGTN with that of operative treatment among children and adolescents.@*METHODS@#All children and adolescents who were treated for IGTN at our institution between 2010 and 2014 were included for this retrospective study. Demographic data, treatment prescribed and outcome at six months after presentation were analysed.@*RESULTS@#Overall, 199 patients were recruited. There were 123 (61.8%) boys and 76 (38.2%) girls. Median age was 14 years. Among 199 toes, 162 (81.4%) were treated nonoperatively, with nail care advice, topical antibiotics and daily cleansing. Only 37 (18.6%) toes were treated operatively. In the operative group, 23 (62.2%) patients underwent wedge resections, while the remaining 14 (37.8%) had total nail avulsions; for all patients, germinal matrices were preserved. At the six-month follow-up, there were 5 (3.1%) cases of recurrence in the nonoperative group when compared to 3 (8.1%) recurrences in the operative group.@*CONCLUSION@#We recommend that IGTN in children and adolescents be treated in the first instance by nonoperative methods. Operative options can be considered for resistant cases or in case of recurrence of IGTN.

Retronychia

Abstract: Retronychia is a recently described disorder caused by ingrowth of the proximal nail plate into the proximal nail fold. It is suspected when there is persistent paronychia, particularly in the setting of trauma. This disease is probably underdiagnosed due to limited knowledge among dermatologists and the presence of incomplete clinical forms. Nail plate avulsion is the diagnostic and curative procedure of choice, despite reports of relapse.

Padronização da técnica cirúrgica de fenolização de matriz ungueal para onicocriptose / Standardization of the nail matrix phenolization surgical technique for treating onychocryptosis

A onicocriptose é afecção bastante comum em adolescentes e adultos jovens. Muitos tratamentos já foram descritos, conservadores e clínicos. Descrevemos a padronização da técnica de cirurgia de onicocriptose com fenol 88% realizada desde 2009 no ambulatório de dermatologia ligado a um serviço universitário.

Onychocryptosis is a common condition in adolescents and young adults. Many conservative and clinical treatments have already been described. The authors of the present paper describe the standardization of the onychocryptosis surgical technique using 88% phenol, which is performed at a university hospital's dermatology outpatient clinic since 2009.

Gutter Splint for Ingrown Toe Nail in Young Patients / 대한족부족관절학회지

PURPOSE: Ingrown toenails are a common disease in the adolescent period and the treatments could be more conservative for this early stage of the disease. This study is a case series on the results of a gutter splint for an adolescent ingrown toe nail as a simple, comfortable treatment method. MATERIALS AND METHODS: From 2011 to 2018, 22 patients (mean age, 12.2 years; range, 8~15 years) with ingrown toenails were treated with a gutter splint. There were 16 boys and 6 girls with 7 patients on both great toes, and additional 4 both corners of a nail, giving a total of 33 splints. Flat, plastic straws and glue or suture were used to protect the nail corners under local anesthesia. The medical records were reviewed retrospectively and phone calls were made to obtain the long-term results. RESULTS: Fifteen splints were fixed with a suture and the other 18 splints were fixed with glue. There were 9 cases of recurrence out of 33 gutter splints, 8 out of 15 sutured splints and 1 out of 18 glued splints (p=0.010). There was no gender (p=0.383) or age (p=0.305) difference in the number of recurrences. CONCLUSION: For growing people, ingrown nails can be cured easily by conservative treatment for a transiently shortened or broken toenail. The glued gutter splint had a reasonable success rate as a first line treatment.

Clinical Research on the Partial Excision of Nail Matrix Combined with Phenolic Ablation in the Treatment of Ingrowing Toenail / 现代生物医学进展

Objective:To investigate the clinical efficacy of partial excision of nail matrix combined with phenolic ablation in the treatment of ingrowing toenail.Methods:115 patients(148 toenails) with ingrowing toenail treated in the Central hospital of Wuhan from October 2004 to May 2013 were selected for this study.The patients were divided into two groups,53 patients(67 toenails) admitted from October 2004 to December 2007 were considered as the observation group and treated with Partial excision of nail matrix,62 patients(81 toenails) admitted from January 2008 to May 2013 were considered as the control group and treated with Partial excision of nail matrix and phenolic ablation.The bleeding time,pain relief time,healing time,recurrences after one year and satisfaction rate of two groups were compared.Results:The wounds of 148 toenails were healing.The Bleeding time,pain relief time,recurrences after one year in the control group (1.85:±:0.42days,13.25± 2.17hours) were lower than the observation group (2.69± 0.53 days,21.54± 2.56hours),and healing time in the control group (11.32± 2.37days) were longer than the observation group (8.93± 2.06 days)(P＜0.05),the recurrence rate and overall satisfaction rate of observation group and control group were 6.15％,12.5％ and 97.06％,91.07％.Conclusion:Partial excision of nail matrix combined with phenolic ablation was more effective in the treatment of ingrowing toenail than surgical excisional techniques.

Anatomical Characteristics and Surgical Treatments of Pincer Nail Deformity

BACKGROUND: Pincer nail deformity is a transverse overcurvature of the nail. This study aimed to define the anatomical characteristics of pincer nail deformity and to evaluate the surgical outcomes. METHODS: A retrospective review was conducted on 20 cases of pincer nail deformity of the great toe. Thirty subjects without pincer nail deformity or history of trauma of the feet were selected as the control group. Width and height indices were calculated, and interphalangeal angles and base widths of the distal phalanx were measured with radiography. We chose the surgical treatment methods considering perfusion-related factors such as age, diabetes mellitus, kidney disease, and peripheral vascular disease. The zigzag nail bed flap method (n=9) and the inverted T incision method (n=11) were used to repair deformities. The outcomes were evaluated 6 months after surgery. RESULTS: The interphalangeal angle was significantly greater in the preoperative patient group (14.0degrees+/-3.6degrees) than in the control group (7.9degrees+/-3.0degrees) (P<0.05). The postoperative width and height indices were very close to the measurements in the control group, and most patients were satisfied with the outcomes. CONCLUSIONS: We believe that the width and height indices are useful for evaluating the deformity and outcomes of surgical treatments. We used two different surgical methods for the two patient groups with respect to the perfusion-related factors and found that the outcomes were all satisfactory. Consequently, we recommend taking into consideration the circulatory condition of the foot when deciding upon the surgical method for pincer nail deformity.

Onicocriptosis unilateral asociada a granuloma piógeno. Presentación de un caso / Unilateral Onychocryptosis Associated with Pyogenic Granuloma. A Case Report

No todas las formaciones que se encuentran asociadas a la onicocriptosis y localizadas en el labio ungueal son granulomas piogénicos, ya que en la mayoría de las ocasiones se trata de una proliferación fibrosa fruto del afán reparativo del organismo. Por tales razones se decidió la presentación del caso de una paciente con onicocriptosis asociada a granuloma piógeno, diagnosticada con anterioridad en el Servicio de Ortopedia del Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos. Esta paciente acudió a la consulta de Podología de la Filial de Ciencias Médicas, por presentar recidiva. Se determinó aplicar la técnica de cirugía menor fenol/alcohol, con resultados positivos.

Not all growths associated with onychocryptosis and located on the ungueal labia are pyogenic granulomas, since in most cases they are fibrous proliferations caused by the reparative response of the body. Hence, we decided to present the case of a patient with onychocryptosis associated with pyogenic granuloma diagnosed earlier in the Orthopedics Department of the Dr. Gustavo Aldereguía Lima University General Hospital of Cienfuegos. This patient attended the Podiatry consultation of the Medical Sciences Subsidiary Faculty due to recurrence. Phenol and alcohol procedure was performed with positive results.

Treatment of Ingrowing Toenails: Comparision of Surgery and Conservative Method Using Memory Alloy / 대한피부과학회지

BACKGROUND: Many techniques for the treatment of ingrown toenails have been described in the medical literature. Surgical removal of the nail plate with partial matricectomy is associated with the lowest recurrence rates. Shape-memory alloy (KD wire) has shown promising results for the treatment of ingrown toenails. However, the results of long term follow-up or a comparison with surgical treatment have not been reported, and the adequate removal time of the wire remains unknown. OBJECTIVE: To compare the results of surgical treatment using partial matricectomy (PM) to those of conservative treatment using KD wire (KD) and to determine the adequate removal time of the wire. METHODS: The KD and PM groups were compared regarding pain relief, quality of life improvement, pain and discomfort during the procedures and 3 weeks after, improvement of nail index by using clinical photos, and patient's satisfaction with the treatments. The nail index improvement in the KD group was compared between postprocedural days 14 and 21. RESULTS: Recurrence was higher (p=.039) in KD group (18.64%) than PM group (6.35%). Patient satisfaction was significantly better (p=0.025) in the PM group than in the KD group. Other parameters showed no significant differences between the two groups. Nail index improvement in the KD group was not significantly different between postprocedural day 14 and day 21. CONCLUSION: Conservative treatment using the KD wire is as effective as surgical removal with partial matricectomy for the treatment of ingrown nails in pain relief, QOL improvement and nail index improvement, but has higher recurrence. The adequate application period of KD is 2 weeks.

Success Rates of Multiple Treatments for Ingrown Nails / 대한피부과학회지

BACKGROUND: An ingrown nail is a common condition of inflammation and infection that can occur when nails are clipped too much or pressure is applied by tight shoes. In Korea, a study on the success of tube insertion after nail guttering has been reported, but studies including other treatments are lacking. OBJECTIVE: To evaluate the success rates of three treatments for ingrown nails: 1) nail splinting via a flexible tube; 2) partial nail extraction and electrocautery; or 3) partial nail extraction and phenol cauterization. METHODS: Fifty-one patients who underwent nail splinting via a flexible tube or partial nail extraction followed by either electrocautery or phenol cauterization of the nail matrix over a 6-year period at our hospital were evaluated for treatment outcome. The disease severity was classified using the Heifetz grading scale. We evaluated the success rates of the various treatments according to reduced disease severity. Treatment failure was defined as persistence or re-occurrence of disease symptoms. RESULTS: 1. Out of 51 cases of ingrown nails, 31 (60%) showed no recurrence after treatment. 2. There were conflicting results between the severity grade and success rate. 3. Treatment via partial nail extraction and either electrocautery or phenol cauterization was more effective (success rates of 63% and 60%, respectively) than nail splinting via a flexible tube (56% success rate). However, the results were not statistically significant. CONCLUSION: Selecting the proper therapeutic method is important for successful treatment of an ingrown nail.

Using 80% trichloroacetic acid in the treatment of ingrown toenails / Acido Tricloroacetico a 80% no tratamento da onicocriptose

BACKGROUND: Ingrown nails are a very common problem. There are different stages of disease and diverse therapeutic options. Phenol and sodium hydroxide are commonly used agents for chemical matricectomy but both frequently entail excessive healing times. OBJECTIVE: This prospective study aimed mainly to evaluate the efficacy of partial nail avulsion and selective chemical cauterization of the matrix using 80% TCA in the treatment of the ingrowing nail. METHODS: One-hundred-and-thirty-three patients with 197 ingrown toenails were included in this study. Preoperatively, we tried to find predisposing factors to the disease. In the postoperative period, patients were evaluated for potential complications at days 3, 30, 180, 270 and 360. Pain was measured before surgery, as well as 24 hours and 72 hours after surgery. RESULTS: There were only 3 cases (out of 197) of ingrown nail recurrence. Preoperatively, we found the presence of drainage in 82% of patients, which, following the first visit after surgery, was reduced to 19%. Persistent granulation tissue was found in 3% of the patients (versus 75% prior to surgery). The most frequent predisposing factors for the ingrown nail were excessive trimming of the lateral nail plate (63%), plantar hyperhidrosis (58%) and heavy nail folds (39%). Pain was substantially reduced after surgery. CONCLUSION: It is assumed that chemical procedures for the ingrown toenail are associated with delayed healing times but our results demonstrated quick recovery. Using 80% TCA for selective matricectomy in the ingrown toenail is an effective, quick and easy method. .

FUNDAMENTO: A unha encravada é uma patologia muito frequente. A doença engloba diferentes estadios existindo diferentes soluções terapêuticas. O fenol e o hidróxido de sódio são largamente utilizados na matricetomia química porém ambos cursam com longos tempos de cura. OBJETIVO: O principal objectivo deste estudo prospectivo foi avaliar a eficácia da mactricectomia com ácido tricloroacético a 80% no tratamento da unha encravada. MÉTODOS: Foram incluídos no estudo 133 doentes com 197 unhas encravadas. Factores predisponentes foram avaliados pré-operatoriamente. No período pós-operatório os doentes foram avaliados para potenciais complicações ao dia 3, 30, 180, 270 e 360. A dor foi avaliada antes da cirurgia, 24 horas e 72 horas depois da cirurgia. RESULTADOS: Ocorreram apenas 3 (em 197) casos de recorrência da unha encravada. Antes da cirurgia registou-se exsudação em 82% dos doentes sendo que na primeira visita após a cirurgia este número foi reduzido para 19%. Observou-se ainda tecido de granulação persistente em 3% dos doentes (versus 75% antes da cirurgia). Os factores predisponentes mais frequentemente encontrados para unha encravada foram o corte excessivo da porção lateral da placa ungueal (63%), hiperhidrose plantar (58%) e pregas ungueais espessadas (39%). A dor teve uma redução dramática após a cirurgia. CONCLUSÃO: É assumido que os procedimentos químicos para a unha encravada estão associados com longos tempos de cura mas os nossos resultados mostraram uma rápida recuperação. No tratamento da unha encravada a matricectomia parcial com ácido tricloroacético a 80% é um método rápido, eficaz e de fácil execução. .

Clinical Study of Efficacy of Super Elastic Wire for Ingrown Nails of Great Toe / 대한피부과학회지

BACKGROUND: Ingrown toenail is one of the most common nail complaints. It occurs mostly on the great toes, where is an excessive lateral nail growth into the nail fold, leading to painful irritation, inflammation, and growth of the granulation tissue. Many treatments have been described, but these classic treatment modalities may lead to severe damage of the nail fold or frequent relapses. OBJECTIVE: We attempted to evaluate the therapeutic efficacy of super elastic wire (SE-wire, Machiwire(R)), a non-invasive treatment for ingrown toenails. METHODS: Fifteen patients with ingrown toenail were treated with super elastic wire. Objective assessment was evaluated by use of the width index (width of the nail tip/width of the nail root) and height index (height of the nail tip/width of the nail root). Subjective assessment was evaluated by use of a visual analogue scale declared by patients. In addition, wound complications and recurrence were described. RESULTS: The width index and height index were improved (width index: 75.0%-->90.0%, height index: 76.5%-->27.7%). Pain was relieved in 100% of the cases. For subjective assessment, all of the patients were satisfied (more than "satisfactory": 100%). There were two relapsed cases during 5 to 12 month period (mean time: 9 months). CONCLUSION: We recommend super elastic wire method as an alternative treatment for ingrown toenail, because it is simple, easy to perform, noninvasive, effective, and well-tolerated.

Ingrown toenails.

Onychocryptosis or ingrown toenail is a very common pathology of the toenail unit, chiefly affecting adolescents and young adults. The ingrown toenail is responsible for disabling complaints like pain and difficulty in walking. It is associated with significant morbidity, hampering the quality of life as it interferes with sporting activities, school, or work. It principally occurs in the hallux. It is ascribed to poor trimming of the nails in combination with local pressure due to ill-fitting footwear, hyperhidrosis, poor foot hygiene and nail abnormalities. Pain, swelling and discharge are the main clinical features. Four stages of the condition have been described. Diagnosis is usually evident, but it should be differentiated from subungual exostosis and tumors of the nail bed. The current standard of care focuses on conservative treatment like the gutter splint technique in the initial stages, and in cases that are resistant to medical management or recurrent, surgical correction is the treatment of choice. There are various surgical techniques that are described in literature. Although there is no ideal technique, lateral nail plate avulsion with lateral matricectomy by phenol is commonly used and reported to be more effective in reducing recurrences. The aim of this review article is to focus on this common pathology of the nail, the various techniques employed in management and aid in the selection of treatment according to the stage and severity of the disease.