Unguis incarnatus
| Classification according to ICD-10 | |
|---|---|
| L60.0 | Unguis inacarnatus |
| ICD-10 online (WHO version 2019) | |
Unguis incarnatus , also known as onychocryptosis , is the medical term for an ingrown nail . Either the side edge of the nail is pressed deep into the nail fold and leads to painful discomfort, or the enlarged nail fold overgrows the side edge of the nail.
A unguis incarnatus mostly affects the big toe. Ingrown nails are one of the most common problems with nails. Men are more often affected than women.
causes
The causes of ingrown nails are usually shoes that are too tight or incorrect nail cutting. If the nail is cut oval like a fingernail, the edge of the nail pushes into the nail bed due to the pressure that the foot may be exposed to from shoes that are too tight. This irritates the skin and causes inflammation . Because the skin is injured, granulation tissue , so-called "wild meat" (connective tissue in the context of wound healing, which is heavily permeated by capillaries . Due to the large number of capillaries, the surface appears "grainy" - it is granulated .) And overgrows the nail, which penetrates deeper into the nail bed. Another possible cause of an ingrown nail is heredity . Particularly at risk here are those whose families have already had previous inflammations of the toenail. The nails are usually clearly convexly deformed ("roller nails").
Secondary diseases
Damage to the skin can cause bacteria to get into the skin and cause inflammation . In severe and untreated cases, osteitis or even bacterial arthritis of the interphalangeal joint of the big toe can occur.
Conservative treatment
A surgical procedure is usually preventable with timely reaction of the person concerned. If the nail has grown in a little, a podiatrist (medical podiatrist) or dermatologist should be consulted immediately .
In the acute, painful early stage (even if the risk of an operation is increased due to a circulatory disorder, for example) it is advisable to tape the inflamed nail . To do this, the wound pad of a plaster strip is pushed between the nail and the inflamed nail wall and the plaster is stuck in a semicircle with tension around the toe so that the nail wall is pulled outwards and the nail has more space. The patient experiences pain relief almost immediately.
In the case of pronounced soft tissue on the nail wall, the podiatrist can also place a flat wedge (nail wedge) in the nail fold and thus relieve the lateral nail wall. It is also possible to splint the nail using silicone tubes cut lengthways.
Another non-surgical treatment method is the application of a nail correction brace (orthonyxis brace) by a podiatrist. If a nail keeps growing in after a treatment, it may also be due to the fact that the nail is too round (in cross-section) and is too deep in the nail fold on the right and left. A podiatrist can remedy this by pulling the nail back up from the sides with a brace treatment. There are different techniques for doing this. The treatment lasts up to 14 months depending on the growth of the nail. When the brace treatment begins, the patient is usually already painless.
If the symptoms persist despite conservative measures, the ingrown nail must be operated on.
Operative treatment
If the nail has grown in chronically, conservative measures are no longer sufficient.
It is often sufficient to remove the corner of the nail that has penetrated the tissue. Then apply a plaster to the area and the problem will be significantly reduced in two to three days. The inflammation is noticeably decreasing. So-called “wild meat” (granulation tissue cells that are supposed to close the wound again) can be observed. If this tissue does not recede, it can be removed by means of "chemical cautery", e.g. B. with 30% trichloroacetic acid, treat.
For follow-up treatment, it is essential to check the cut edge after the inflammation has subsided in order to round it off with a fine milling cutter. Any slipping of cotton wool or other "tamponades" should be avoided, as these are usually not tolerated and often cause new inflammations. Acute inflammations - if no surgery is desired - can usually be brought under control with the antibiotics cefuroxime or clindamycin.
If there is a risk that the nail will grow in again after braces treatment, part of it is usually removed and a surgical nail bed reduction ( nail wedge excision , synonymous with Emmert plastic ) may be carried out. This means that not only the nail itself but also the part of the nail bed and the nail matrix are removed. As a result, the newly growing nail becomes narrower and the risk of it growing back in should be reduced, because the Emmert plastic and related methods are based on the assumption that an unfavorable nail shape (too wide, too curved, according to "Rollnagel" or unguis called convolutus) causing the disease. Partial nail removals are also performed under local anesthesia . Additional analgesic sedation is more pleasant because of the painful so-called Oberst conduction anesthesia. The sole Oberst anesthesia is perceived by practically all patients as painful, which can be avoided by the aforementioned measure.
On the other hand, there is the view that instead a widened nail wall is the cause, i.e. the soft tissue that overgrows the nail edge due to pressure. According to this theory, such tissue should be removed ( Vandenbos plastic ). The nail wall is narrowed close to the nail edge, but the healthy nail is preserved in its natural shape and width. The resulting defect wound heals more slowly (around six to eight weeks), which is the main disadvantage of the method. The low recurrence and infection rates of this approach compared to other approaches were described as "encouraging". Overall, however, the statistical data are insufficient and do not yet allow a general recommendation for or against a specific procedure.
Web links
Sources and individual references
- ↑ OM Mainusch, CR Löser: Ingrown toenails - options for daily practice . In: dermatologist . tape 69 , no. 9 . Springer Medizin Verlag, September 2018, ISSN 0017-8470 , p. 726-730 .
- ↑ a b c Hans Otto fence, Dorotheenstraße Dill-Müller: Pathological changes of the nail. 9., revised. Edition. 2004, ISBN 3-934211-69-0 , p. 79.
- ↑ chirurgie-bad-laer.de
- ↑ Taping instantly relieves pain. In: Medical Tribune. No. 47, November 24, 2000, p. 35.
- ↑ With reference to Professor Dr. Eckart Haneke, Bunoes Clinic, Sandvika, Norway; see. Taping instantly relieves pain. In: Medical Tribune. P. 35.
- ↑ Ingrown toenail , Gesundheitsinformation.de accessed on November 6, 2018.
- ↑ Tips against ingrown toenails. In: online pharmacies. accessed on November 6, 2018.
- ↑ Jörg Carls, Nikolaus Wülker: Therapy of wound infections on the forefoot. In: D. Clemens, G. Rompe (Ed.): Orthopädische Praxis . No. 4 . ML Verlag, April 4, 1998, ISSN 0030-588X , p. 244-248 .
- ↑ S. Rammelt, R. Grass, H. Zwipp: For the treatment of the ingrown toenail. What is an "Emmert plastic"? In: surgeon . tape 74 , no. 3 . Springer Medizin Verlag, Berlin, p. 239-243 .
- ↑ KQ Vandenbos, WP Bowers: Ingrown toenail: a result of weight bearing on soft tissue . In: US Armed Forces Medical Journal . tape 10 , no. 10 , 1959, pp. 1168-1173 .
- ↑ Eckart Haneke: Controversies in the Treatment of Ingrown Nails. In: Dermatology Research and Practice. 2012, Article ID 783924, doi: 10.1155 / 2012/783924
- ^ Bertrand Richert, Nilton Di Chiacchio, Marie Caucanas: Management of Ingrowing Nails: Treatment Scenarios and Practical Tips . Springer International Publishing, 2016, ISBN 978-3-319-30555-4 , pp. 104 ( google.com ).
- ↑ a b Michael B. DeBrule: Operative Treatment of Ingrown Toenail by Nail Fold Resection Without Matricectomy . In: Journal of the American Podiatric Medical Association . tape 105 , no. 4 , July 2015, ISSN 8750-7315 , p. 295–301 , doi : 10.7547 / 13-121.1 ( japmaonline.org [accessed January 27, 2020]).
