COMMENTARY

Ingrown Toenails -- Straighten or Remove?

Albert B. Lowenfels, MD

Disclosures

March 10, 2008

Partial Matrix Excision or Orthonyxia for Ingrowing Toenails

Kruijff S, van Det RJ, van der Meer GT, van den Berg IC, van der Palen J, Geelkerken RH
J Am Coll Surg. 2008;206:148-153

In this report, the authors present findings evaluating 2 surgical options for treating ingrown toenails: partial excision of the matrix (58 patients), or orthonyxia (51 patients), in which the operator first removes the offending symptomatic nail spicule and then applies a metal strut to the dorsum of the nail. The main study endpoint was the rate of recurrence. The frequency of recurrence at 1 year was similar in the 2 groups (partial matrix excision = 4, orthonyxia = 8, P = .14), but orthonyxia improved postoperative recovery, which was measured as bleeding, pain, and ability to wear shoes.

Ingrown toenails are common complaints often requiring treatment by a surgeon or podiatrist. This study compared 2 different therapeutic options -- partial excision of the nail root vs straightening of the offending nail (orthonyxia). Occasional recurrences required additional treatment in about 3% to 4% of patients in both groups. The recurrence rate was somewhat higher with orthonyxia, but it did lead to a speedier recovery. Furthermore, orthonyxia is straight-forward and cheaper than conventional partial excision of the nail matrix.

Abstract

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