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INGROWN TOENAIL (ONYCHOCRYPTOSIS)

from greek: (onyx, "nail") + (kryptos, "hidden) which


means the nail grows into the nailbed.
One of common form of nail diseases.
ETIOLOGY
Improper debridement by the patient can lead to ingrown nails.
Ill-fitting shoes may also be a causative factor.
The presence of a subungual exostosis has been stated to be the
pathogenesis.
Excess soft tissue growing.
Hypermobility of the first metatarsal segment and hallux valgus.
Trauma to the nail matrix or nail bed.
CLINICAL MANIFESTATION
Discomfort
Pain
Crusting, purulence, and friable granulation tissue.
PHYSICAL EXAMINATION
Upon examination, the following may be present:
Edema or inflammation of tissue surrounding the nail bed
Erythema of the same tissue
Macerated or friable granulation tissue
Crusting
Drainage
Hypertrophy of the nail margin
Hypertrophy of the surrounding epidermis
CLASSIFICATIONS & STAGES
Symptomatic or non-symptomatic ( infected or non-infected)
Stage 1: Mild erythema edema and pain with pressure
Stage 2: Significant erythema, edema, local infection, and discharge
Stage 3: Granulation tissue formation and hypertrophy of the lateral
wall besides the significant erythema, edema, and discharge
TREATMENT & MANAGEMENT
Medical care -> conservative management used in ingrown nails stage
1
General Measures:
- Use well fitted shoes
- Trim toe nails properly
- Manage underlying possible predisposing factors such as
onychomycosis and hyperhidrosis.
- Soak the affected toe in warm water, followed by application of
topical antibiotics or silver nitrates in case there is granulation tissue.
CONSERVATIVE METHODS
COTTON WICK
Cotton wick insertion in the lateral groove corner is one method. Using
a nail elevator or small curette, small wisps of cotton are inserted
under the lateral edge of the ingrown nail. Symptomatic improvement
was reported in 79% of patients in a case series with mean follow up of
24 weeks.
TOE TAPING
he affected toe is taped in a way that the one end of the tape is placed
on the side of the ingrown nail along the granulation tissue and twisted
around the toe at an angle, with the other end overlapping the first
without covering the wound itself. This taping allows drainage of
accumulated pus, drying of the wound, and decreasing the pressure on
the nail bed.
NAIL SPLINTING
Nail splinting by flexible tube (gutter treatment) involves a small
sterilized vinyl intravenous drip infusion tube, which is cut and slit
appropriately from top to bottom with one end cut diagonally for
smooth insertion. The lateral edge of the affected nail plate is splinted
with this tube under local anesthesia. The plastic tube is then covered
by adhesive or wound closure strips and the patient is instructed to
wash his or her toe daily with povidone iodine solution for 3-4 weeks.
This method allows the nail spicule to grow without injuring the nail
fold, and the inflammatory process will subside.
The split tape-strap technique is a procedure that involves elastic tape
cut into pieces about 3 cm wide and about 10 cm long, folded
longitudinally in half. A slit is then created on the width of the ingrown
nail along the short edge of one third of the tape length. The ingrown
nail is then inserted in the slit, orienting the tape with the shorter side
of the tape towards the dorsal side of the toe and hooking the slit edge
of the longer side on the ingrown nail and attaching it to the plantar
surface of the toe. This procedure showed favorable results as
monotherapy or when combined with other conservative procedures.
SURGICAL CARE
Complete nail evulsion
Partial nail evulsion
Wedge matrix excision
Partial matrix excision
Total matrix excision
Vandenbos procedure
GANGLION CYST
DEFINITION
Ganglion cysts are noncancerous lumps that most commonly develop
along the tendons or joints of your wrists or hands.
They also may occur in the ankles and feet. Ganglion cysts are
typically round or oval and are filled with a jellylike fluid.
CAUSES
The cause of these cysts is unknown although they may form in the
presence of joint or tendon irritation or mechanical changes. They
occur in patients of all ages.
These cysts may change in size or even disappear completely, and
they may or may not be painful. These cysts are not cancerous and
will not spread to other areas.
SYMPTOMS
The lumps associated with ganglion cysts can be characterized by:
Location. Ganglion cysts most commonly develop along the tendons
or joints of your wrists or hands. The next most common locations are
the ankles and feet. These cysts can occur near other joints as well.
Shape and size. Ganglion cysts are round or oval and usually measure
less than an inch (2.5 centimeters) in diameter. Some are so small
that they can't be felt. The size of a cyst can fluctuate, often getting
larger when you use that joint for repetitive motions.
Pain. Ganglion cysts usually are painless. But if a cyst presses on a
nerve even if the cyst is too small to form a noticeable lump it
can cause pain, tingling, numbness or muscle weakness.
DIAGNOSIS
Trans-illumination test : the light will often pass through these lumps
X-ray
TREATMENT
Ganglion cysts are often painless, requiring no treatment. Your doctor may
suggest a watch-and-wait approach.
If the cyst is causing pain or interfering with joint movement, then we can do
these :
Immobilization. Because activity can cause the ganglion cyst to get larger, it
may help to temporarily immobilize the area with a brace or splint. As the cyst
shrinks, it may release the pressure on your nerves, relieving pain. Avoid long-
term use of a brace or splint, which can cause the nearby muscles to weaken.
Aspiration. In this procedure, your doctor uses a needle to drain the fluid from
the cyst. The cyst may recur.
Surgery. This may be an option if other approaches haven't worked. During this
procedure, the doctor removes the cyst and the stalk that attaches it to the
joint or tendon. Rarely, the surgery can injure the surrounding nerves, blood
vessels or tendons. And the cyst can recur, even after surgery.
LIFE STYLE & HOME REMEDIES
Analgesic ( ibuprofen, naproxen, diclofenac)
An old home remedy for a ganglion cyst consisted of "thumping" the
cyst with a heavy object. This isn't a good solution because the force
of the blow can damage surrounding structures in your hand or foot
Also don't try to "pop" the cyst yourself by puncturing it with a
needle. This is unlikely to be effective and can lead to infection.