Management of Bilateral Ingrown Toenail: Partial Permanent Nail Ablation
Bilateral partial permanent ablation of the right first toenail is the most appropriate treatment approach for this 64-year-old male patient with bilateral ingrown toenail. 1
Assessment and Indications
When evaluating an ingrown toenail affecting both sides of the toe, consider:
- Extent of nail involvement (bilateral in this case)
- Presence of pain, infection, or inflammation
- Functional impairment
- Patient risk factors (age, comorbidities)
The bilateral involvement of the first toenail indicates a more severe condition that requires definitive treatment rather than conservative measures alone.
Treatment Approach
First-line Treatment: Surgical Management
For bilateral ingrown toenails, especially in older adults, surgical intervention with partial nail avulsion and matricectomy is recommended:
- Partial nail avulsion with matricectomy: Remove the lateral edges of the nail plate and destroy the corresponding nail matrix to prevent regrowth 1, 2
- This approach is superior to nonsurgical treatments for preventing recurrence 2
Surgical Technique Options
Chemical matricectomy:
- After partial avulsion of the lateral nail edges
- Application of phenol to destroy the lateral nail matrix
- Offers controlled tissue destruction with excellent success rates 3
Electrosurgical matricectomy:
- May offer more controlled tissue destruction
- Potentially less postoperative drainage than chemical methods 3
Post-Procedure Care
- Clean the nail bed and apply topical antibiotic ointment with sterile dressing 1
- Monitor for signs of infection
- Elevate the foot to reduce swelling
- Limited weight-bearing initially
- Follow-up within 1-2 weeks to ensure proper healing 1
Special Considerations for This Patient
For a 64-year-old male patient:
- Age-related factors may affect healing time
- Assess for diabetes or vascular issues that could complicate healing
- Consider proper footwear recommendations post-procedure
Prevention of Recurrence
After successful treatment:
- Educate on proper nail trimming technique (straight across)
- Recommend properly fitting shoes with adequate toe box
- Consider urea-based creams for nail care if the nail is thickened 4
- Regular podiatric follow-up, especially if the patient has risk factors for foot complications
Potential Complications
- Secondary infection
- Permanent nail deformity if the matrix is damaged during the procedure
- Recurrence if matricectomy is incomplete
Follow-up Recommendations
- Initial follow-up within 48-72 hours if signs of infection develop
- Routine follow-up in 1-2 weeks to assess healing
- Long-term monitoring to ensure no recurrence
Bilateral partial permanent ablation offers the most definitive treatment for this patient's condition, addressing both the current problem and preventing future recurrence of the ingrown toenail.