Key points on ingrown toenail management:
1. Common presentation to primary care, especially in adolescent boys. It is typically located along the lateral edges of the great toenail and represents and imbalance between the soft tissues of the nail fold and the growing nail edge.
2. It is exacerbated by faulty nail trimming, constricting shoes and poor hygiene. Other risk factors include: male, 14-25 age group, isotretinoin use and thickening of the nail plate.
3. All patients should be instructed on correct foot and nail care. Foot hygiene includes foot baths, avoiding nylon socks and frequent changes of cotton or wool socks. It is important to fashion the toenails so that the corners project beyond the skin. (Figure 1)
4. Surgical nail excision is an easy procedure. GPs should learn how to do it.
5. There are many different ways of removing the lateral toenail. The principles are the same. Remove the part of the nail that is digging into the skin and prevent it from happening again. The following youtube video showed a technique that we use in our GP practice
6. https://youtu.be/XVDYb6ubt7I
7. The following video gives a good illustration of how to do a digital block: https://youtu.be/l2Zl15LFQWQ
8. I use the phenol ablative technique and it is well described in reference 2
9. The first time when you do it, it is better to have someone there to supervise. Once you have done it for a few times, you will be able to do it. It is not a difficult procedure.
Reference:
1. John Murtagh's General practice 5th edition
2. http://www.racgp.org.au/afp/2015/march/ingrown-toenails-the-role-of-the-gp/
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