From the Guidelines
The most effective note template for a 28-year-old female patient with bilateral onychocryptosis (ingrown toenails) should prioritize conservative management with warm foot soaks, gentle nail lifting, and pain management, as well as preventive measures to avoid future occurrences, as supported by general medical knowledge and guidelines for similar conditions, such as paronychia 1.
Assessment and Diagnosis
The patient presents with bilateral ingrown toenails, characterized by inflammation and pain at the lateral nail borders of both great toes. Assessment should include evaluation for signs of infection, such as increased pain, purulent discharge, or spreading redness.
Treatment Plan
The treatment plan should include:
- Conservative management with warm foot soaks in Epsom salt solution (1 tablespoon per quart of water) for 15 minutes three times daily to reduce inflammation and pain.
- Gentle lifting of the ingrown nail edge using a cotton wisp soaked in antiseptic solution and placing it under the nail edge to help separate the nail from the surrounding skin.
- Recommendation to wear open-toed shoes or sandals temporarily to reduce pressure on the toes.
- Prescribing ibuprofen 400mg every 6 hours as needed for pain and inflammation management.
Follow-Up and Preventive Measures
If conservative measures fail after 1-2 weeks or if signs of infection develop, the patient should return for further evaluation and possible partial nail avulsion with phenolization. Preventive measures should include:
- Proper nail trimming technique, trimming straight across and not rounding the corners.
- Wearing properly fitting shoes to avoid pressure on the toes.
- Maintaining good foot hygiene to prevent infection.
Rationale
The approach is based on general principles of managing similar conditions like paronychia, where prevention of further irritation and infection, along with symptomatic relief, are key 1. While the provided study focuses on paronychia in the context of anticancer agents, the principles of gentle skin care, prevention of infection, and management of symptoms can be applied to the treatment of ingrown toenails.
From the Research
Note Template for Bilateral Onychocryptosis
The note template for a 28-year-old female patient with bilateral onychocryptosis (ingrown toenails) may include the following information:
- Patient's demographics and medical history
- Chief complaint: bilateral ingrown toenails
- History of present illness:
- Duration of symptoms
- Previous treatments or interventions
- Associated symptoms such as pain, swelling, or discharge
- Physical examination:
- Description of the affected toenails
- Presence of any signs of infection or inflammation
- Diagnosis: bilateral onychocryptosis (ingrown toenails)
- Treatment plan:
- Conservative management for early-stage symptoms, such as proper nail trimming and foot hygiene 2, 3
- Surgical interventions for severe or recurrent cases, including partial nail extraction and matrix destruction 4, 5
- Consideration of new surgical techniques, such as partial nail avulsion using an 11-blade surgical knife 6
- Patient education:
- Proper nail trimming techniques to prevent recurrence 2
- Foot hygiene and self-care instructions
- Follow-up plan:
- Scheduled follow-up appointments to monitor progress and adjust treatment plan as needed
Possible Treatment Options
Possible treatment options for bilateral onychocryptosis may include:
- Conservative management:
- Gutter splint technique
- Nail trimming and foot hygiene instructions
- Surgical interventions:
- Partial nail extraction
- Matrix destruction
- Lateral nail plate avulsion with lateral matricectomy by phenol
- New surgical techniques, such as partial nail avulsion using an 11-blade surgical knife 6
Considerations for Recurrence
Considerations for recurrence of ingrown toenails include: