Can A New Brace Provide A Treatment Alternative For Ingrown Toenails?

By Brian McCurdy, Associate Editor

While the matrixectomy is a common procedure of choice for ingrown toenails, researchers from Germany believe an orthonyxia procedure, delivered via a new brace, may be more effective in treating these toenails. In a study, which was recently published in the Journal of the American Podiatric Medical Association (JAPMA), the researchers found that patients who wore the brace experienced reduced pain and a quicker return to work than those who underwent surgery. However, a couple of DPMs are skeptical. The recent study in JAPMA examined 41 patients with ingrown toenails. Twenty received the Emmert surgical procedure, which is a standard procedure in Germany. Twenty-one patients received orthonyxia via the VHO-Osthold Brace. Orthonyxia consists of implanting a small metal brace or plate onto the dorsum of the nail, according to the researchers. Although both groups had pain at similar levels before treatment, study results showed pain resulting from treatment was “significantly lower” in patients who received a brace than in those who underwent the Emmert procedure. The study authors also pointed out that those wearing the brace could wear shoes without pain earlier than those who underwent the surgery. Patients who received the brace did not take time off from work while 10 of the patients who underwent the surgical procedure needed an average of 14.7 days off from work postoperatively. Although basic treatment costs were higher for the brace group versus the Emmert surgery group, researchers note that the time off from work raised the total economic cost to $1,975.20 for the surgical group compared to $334.30 in the brace group. Alexander Reyzelman, DPM, has used a similar orthonyxia brace before and thinks patients should receive that option for ingrown toenail treatment. However, Dr. Reyzelman does not find bracing appropriate for patients with a paronychia. He says these patients should undergo surgery instead. John Mozena, DPM, recalls a glued-on plastic brace for ingrown toenails that was introduced about 10 years ago and that it did not gain acceptance among podiatrists. Dr. Mozena finds the orthonyxia procedure described in the JAPMA study similar to the plastic brace of a decade ago. “The procedure orthonyxia looks like a lot of work and seems painful to me,” says Dr. Mozena, a Fellow of the American College of Foot and Ankle Surgeons. How Does Orthonyxia Compare To Matrixectomies? Study authors compared the Emmert procedure to the Winograd procedure, which Dr. Mozena says involves stitches. He notes the surgery also has a longer recuperation time than phenol or laser matrixectomies, which he says let patients return to work the next day. Dr. Reyzelman also notes the most common care for ingrown toenails is no longer surgery but chemical matrixectomy. He notes differences in pain and time off from work would be “much less significant” if one compares orthonyxia with chemical matrixectomy. “The chemical matrixectomy procedure is much less painful than the surgical matrixectomy and patients rarely take time off work,” notes Dr. Reyzelman, the Chairman of the Department of Medicine at the California College of Podiatric Medicine at Samuel Merritt College. While patients may favor any non-surgical procedure such as orthonyxia, Dr. Mozena says the bracing procedure is mildly invasive and the study’s conclusions about pain and time off from work are “misleading. “I feel we still should continue our current conservative and surgical approaches to treatment of infected ingrown nails that deals with the hypertrophic ungual labia and deformed nail itself,” comments Dr. Mozena. Congress Delays Action On Physician Payments, Diabetes Program Cuts By Brian McCurdy, Associate Editor When Congress adjourned for its winter break, it delayed action on several expected pieces of legislation. As a result, legislators did not avert a 4.4 percent decrease in the Medicare physician fee schedule, part of a bill expected to be passed in late December. In addition, when Congress reconvenes in early February, a diabetes surveillance program may face decreased funding. As part of Congress’ appropriations bill, legislators were expected to cut funding to the Division of Diabetes Translation, according to the American Diabetes Association (ADA).

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