Important items to consider in the history:

• Etiology

  • Improper nail trimming (nails should be cut straight across)

  • Improper shoe gear (a narrow or tight toe box)

  • Trauma (resulting in irregular growth)

  • Genetic predisposition (check family history)

  • Painful nail fold due to incurvated nail border.

  • Previous occurrence and recurrence after procedure

• Differential diagnosis:

  • Paronychia - Infection of nail fold due to irritation without presence of incurving nail.

  • Onychomycosis (fungal nails) - Thickening of nail due to fungal infection, bacterial infection uncommon.

Physical exam will show:

• Edema

• Erythema

• Warmth of the nail fold, usually the lateral nail fold.  

• If present for a period of time, localized infection may produce serosanguanous or purulent drainage.  

• Lymphangitis is uncommon but may be present in very neglected situations.  

• Granulomatous tissue (proud flesh) may be present chronic cases.

Treatment:

If unable to perform procedure, use soaks and antibiotics

Procedure.  This is a clean but not sterile procedure.

• Set up equipment

• Scrub the foot

• Digital block (1% or 2% xylocaine without epinephrine)

• Inject the proximal digit on medial and lateral aspect with 3cc

• Loosen the skin overlying the nail fold

• Use thin elevator to free the nail from the nail bed

• Use nail cutter (English anvil) to cut the nail to matrix

• Use hemostat to remove nail

• Phenol (89%) application if permanent ablation of nail matrix (root) is desired in

• Intractable cases - 2 applications for 30 sec., then neutralize with alcohol

• Place topical antibiotic, dressing

• Daily dressing changes for 5 days (longer with phenol procedure)

• Domeboro or Epsom salts soaks for 1 week (longer with phenol procedure)

Christopher Kardohely, DPM, HM2 (FMF) George Pugh,  and Scott D. Flinn, MD

For further information, read:

Operational Podiatry, in the General Medical Officer Manual

Approved for public release; Distribution is unlimited.

The listing of any non-Federal product in this CD is not an endorsement of the product itself, but simply an acknowledgement of the source. 

Operational Medicine 2001

Health Care in Military Settings

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