From the Guidelines
When documenting onychocryptosis (ingrown toenail) of the right great toe on physical examination, describe the nail as partially or completely embedded into the lateral and/or medial nail fold of the right hallux, noting the presence and degree of inflammation, erythema, swelling, tenderness, and pain, as these are key factors in determining the severity of the condition and guiding treatment decisions 1.
Key Components of Documentation
- Note the exact location of the ingrowth (medial edge, lateral edge, or both) and estimate the extent of nail penetration into the soft tissue
- Document any secondary findings like paronychia, cellulitis, or abscess formation, as these may require additional treatment or intervention 1
- Include the appearance of the nail itself, including thickness, discoloration, or deformity that might contribute to the condition
- Specify the patient's pain level during examination and any difficulty with ambulation, as these can impact treatment decisions and overall management of the condition
Importance of Detailed Documentation
Detailed documentation of onychocryptosis is crucial in establishing the severity of the condition and guiding appropriate treatment decisions, whether conservative management or surgical intervention is warranted, and can help identify potential complications or secondary infections, such as paronychia, which can be graded according to CTCAE v5.0 and treated accordingly 1.
From the Research
Description of Onychocryptosis on Physical Examination
Onychocryptosis, also known as ingrown toenail, is a pathologic condition of the nail apparatus where the toenail damages the nail fold, causing pain, inflammation, and functional limitation 2. It commonly occurs in the hallux, or big toe.
Key Characteristics
- The condition is characterized by the penetration of the lateral border of the nail plate into the lateral nail fold, causing pain and inflammation in the surrounding tissue 3.
- Symptoms range from erythema, edema, and pain when pressure is applied on the nail fold, up to secondary infection and functional impotence 3.
- Onychocryptosis can be described as a mechanical onicopathy, almost exclusively of the first toe, which recognizes multiple causes 3.
Documentation of Onychocryptosis of the Right Big Toe
When documenting onychocryptosis of the right big toe on physical examination, it is essential to note the presence of pain, inflammation, and any signs of infection. The description should include the location of the onychocryptosis, which in this case is the right big toe, and the stage of the condition, if classified according to a specific system 2, 4.
Classification and Treatment
Onychocryptosis can be classified into different stages, with corresponding treatment plans 2, 4. The treatment approach may involve conservative management, such as proper wound treatment and nail bracing, or surgical interventions, including various techniques to alter the nail plate or diminish periungual tissues 4, 5.
Specific Description
A specific description of onychocryptosis of the right big toe on physical examination might include: