Ingrown toenail (onychocryptosis or unguis Incarnatus): Pattern and treatment outcome among patients seen in a secondary health facility over a three-year period

Abstract

Background: In-grown toenail is an irritating lesion often encountered in clinical practice. It is not uncommon in our environment. It is largely a lesion of tight-fitting shoes, trauma to unshod toes or poorly trimmed toenails among many other risk factors identified epidemiologically. Though not lifethreatening, in-grown toenail affects the quality of life by causing pain, limiting comfort and activity among those affected. Treatment may be conservative in the early stages but when recurrent or seen in late-stage, surgery offers a better and lasting outcome.
Objective: We aim to identify the risk factors and distribution of in-grown toenails among our patient population as well as the outcome of surgical treatment.
Method: This is a cross-sectional prospective study. We collected demographic and clinical data from consecutive patients presenting with In-grown toenails to a single secondary health facility in a semiurban area of Lagos, over three years using a questionnaire Pro-forma.
Result: We harvested a total of 138 lesions involving 120 toes in 99 patients. There were 53 Males and 46 Females (M/F ratio is 1.2:1), with ages ranging from 10 to 71 years. (Mean 32 years). All lesions involved the great (Big) toe only. 78 patients had unilateral great toe lesions. The majority attributed the cause to wearing tight shoes (51%) or poor trimming of nails (46%). The patients were offered partial or complete
great toenail excision plus debridement and recorded no recurrence after follow up period ranging from 6 to 24 months. Eight (8) patients refused surgical treatment and preferred to heed conservative advisory measures.
Conclusion: Wearing of tight, tapered-tip, ill-fitting footwears as well as poor nail-trimming techniques, alone or in combination increases the risk of developing ingrown toenails more than direct trauma to unshod feet. The majority of our cases have multiple risk factors. Surgical treatment provides a better outcome with minimal recurrence for latestage or after failed conservative management.