Reason for attending the office: This patient attended complaining of a right big toenail that was curling, getting worse over the prior 3-4 years.  There was pain on pressure on the tip of the right big toenail and the pain was exacerbated by the nail curling.  

Agreed treatment:  On assessing this troublesome nail it became apparent that the patient was suffering from an involuted toenail – a type of ingrown toenail where the edges of the nail curve downwards to much.  The patient was already trying to manage the painful curling nail with frequent pedicuresAfter discussing treatment, it was mutually agreed that a nail surgery procedure would the best curative long-term treatment option.  This minimally invasive procedure is carried out in the office under surgical conditions to permanently remove the problem portion(s) of an ingrown toenail.  The aim of this treatment was to remove the problematic curling edges of the toenail, leaving the healthy central nail intact, and to prevent the problematic parts of the nail regrowing.  This procedure suited the patient due to the ease of treatment and minimal discomfort.

Alternative Treatment Discussed:  The option of frequent, professional nail care in our office by a chiropodist to try and minimize recurrent and ongoing pain could be an option.  The patient elected to opt for a more permanent solution rather than committing to a frequent chiropody care visit.

Outcome: Total healing following the procedure was 22 days.

Timeframe: At 4 ½ Months a cosmetic review was undertaken and the result was pleasing and the toenail was looking cosmetically good.

Conclusion: This is an example of how we aim to remedy a painful, deformed, infected or troublesome toenail using common nail surgery procedures and techniques.

Please note that in most evidence hierarchies current, well designed systematic reviews and meta-analyses are at the top of the hierarchy, with single case studies, expert opinion and anecdotal experience at the bottom. 

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