Onychocryptosis, Onychogryposis, Onychomycosis and Onychocyrtosis: A Clinical Review of Surgical Treatments

Background: Ingrown toenail (onychocryptosis) is one of the most common ailments of the toe. Treatment of onychocryptosis is often associated with pain and disfigurement of the nail. The most common presentation of onychocryptosis is distal lateral ingrowing. Conservative treatments available include: packing, taping, gutting and foot baths. Surgical methods in the literature vary. Three surgical methods used in this patient cohort included: 1) radical partial toenail excision 2) simple toenail removal and 3) toenail removal with complete nail plate ablation.

Methods: Clinical charts over the past ten years were reviewed for the above four toenail conditions at Toronto Western Hospital Fracture Clinic. The following data was collected from 63 eligible patient records: gender, age, laterality, surgical method, comorbidities and treatment results.

Results: Study patients included 27 men (mean age 40; SD 19) and 36 women (mean age 51; SD 20). Laterality of the affected foot was 40% left, 41% right and 19% bilateral. The great toe was most commonly affected with eight cases involving lesser toenails. Of the total cohort: 32 patients presented with onychocryptosis, 22 onychogryposis, 6 onychomycosis and three subungual exostosis. The majority (37) were treated with partial radical toenail excision (medial border: 12; lateral border: 15; both borders: 10). Patients underwent simple nail removal in 23 cases, while three were treated with complete nail plate ablation. Recurrence was observed in five cases and three developed mild redness and/or swelling post operatively.

Conclusions: There is no consensus on the most recommended treatment for the above four nail conditions. This review studied three surgical methods of treatment. The majority of onychocryptosis patients obtained lasting relief from radical partial nail excision. No major side effects or recurrences were experienced in this cohort. Future studies should be performed in a randomized fashion prospectively to determine the optimal surgical treatment method.