Case Study – Painful Nail

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A 17-year-old male (Aaron) presented to the clinic with a very painful, swollen big toe on his right feet. This was caused by the edge of the nail becoming ragged and the shard digging into the area of skin at the side of the toe.

This is the classic presentation of an ingrown toenail which is also known as onycho-cryptosis.

There are a few solutions for this including conservative management, reducing the nail and allowing the leading edge of the nail to grow out. In Aarons case though, removal of the offending nail section was discussed and chosen as the most appropriate treatment route.

This was due to Aaron being an active teenager and the more advanced stage that the ingrowing toe presented as. Removal of just the side portion of the nail allows immediate relief to be felt and a relatively quick healing time to be achieved.

Local anaesthetic was then used to numb the area, the offending section of the nail was then removed. A chemical called Phenol is then applied, this treats the nail bed preventing that section of the nail from growing back.

A dressing was then applied with advice for Aaron on how to manage this when returning home. We normally recommend the use of generic painkiller when returning home and at least a day of rest to ensure a good start to the healing process.

I felt so relieved as my toe wasn’t sore anymore, even after the anaesthetic wore off!”  – Aaron

Aaron then attended a series of four dressing appointments where the toe was monitored by our team and sequentially smaller dressings were used.

After 6 weeks the area had dried up and Aaron was ready to leave his toe uncovered and fully return to normal activity.The area has now completely healed and no regrowth has occurred.

To prevent other nails from ingrowing, Aaron was shown correct nail cutting technique for his nail shape and what to watch out for in the future.

*Names have been changed to protect patient identity.*

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