Briefly discuss the aetiology of an ingrown toenail

The aetiology of an ingrown toenail is multifactorial. The condition is rare in people who do not wear shoes. Mechanical pressure from the shoe on the medial nail fold and pressure from the second toe on the lateral nail fold and onto improperly trimmed toenails will result in breaks in the skin of the nail folds. This is then complicated by bacterial and/or fungal infection, which results in inflammation and eventually abscess formation.

What conservative measures can be used in treating an ingrown toenail?

• Foot hygiene with regular daily soaks.

• Proper trimming of the toenails (square ends).

• Placing cotton wool under the corner of the nail to lift the nail from its embedded position.

• In cases of infection appropriate antibiotics can be given.

What is Zadik's procedure and how do you perform it?

This refers to a total removal of the nail plate (the nail) and the germinal matrix to prevent recurrence.

Position It is supine and it can be performed under a GA or a ring block. A rubber tourniquet is applied to the great toe.

Procedure Two oblique incisions are made from both corners of the proximal nail folds approximately 1 cm proximally and the eponychium is raised as a full-thickness flap. The nail plate is loosened and removed using a straight haemostat. The germinal matrix is then completely excised ensuring none is left behind.

Closure The eponychium flap is then closed and the big toe is dressed with non-adherent dressing. The tourniquet is released.