From the Research
The most appropriate management for a 28-year-old female presenting to primary care with an ingrown toenail is the "Steri-strip sling technique", a simple and effective outpatient procedure that has shown significant relief in pain and high patient satisfaction levels with no reported complications, as demonstrated in a recent prospective study 1.
Key Considerations
- The patient's condition should be classified as Stage 1 (mild with pain/erythema), Stage 2 (moderate with infection/drainage), or Stage 3 (severe with significant granulation tissue) to determine the best course of treatment.
- Conservative measures such as warm soaks, proper nail trimming, and cotton wick placement may be sufficient for mild cases, while oral antibiotics may be necessary for infected cases.
- Procedural intervention, including partial or complete nail avulsion with possible phenolization, may be required for severe or recurrent cases.
Treatment Approach
- The "Steri-strip sling technique" involves inserting a steri-strip between the disto-lateral edge of the nail plate and nail fold, securing it with an elastic bandage, and keeping the dressing in place until the nail edge grows over the nail fold and stops penetrating the skin.
- This technique has been shown to be effective in managing mild to moderate ingrown toenails, with 46 out of 50 patients reporting satisfaction with the treatment and no recurrence after 6 months 1.
Patient Education
- Proper nail trimming techniques, including trimming straight across and not too short, should be taught to the patient to prevent recurrence.
- Appropriate footwear recommendations and follow-up instructions should also be provided to ensure optimal outcomes.
Relevant Evidence
- A study published in the Indian Journal of Dermatology in 2024 found that the "Steri-strip sling technique" was a simple and effective outpatient procedure for managing mild to moderate ingrown toenails, with significant relief in pain and high patient satisfaction levels 1.
- Other studies have also highlighted the importance of conservative measures and procedural intervention in managing ingrown toenails, depending on the severity of the condition 2, 3, 4, 5.