Study Sparks Debate About Treatment Options For Ingrown Toenails

Brian McCurdy, Senior Editor

Patients commonly present with ingrown toenails and treatments range from chemical matrixectomy to the newer orthonyxia procedure. A new study in the Journal of the American College of Surgery concludes that orthonyxia, using a metal brace for the toe, is superior to partial matrix excision in terms of recovery and patient satisfaction.
Researchers randomized 105 consecutive patients with 109 toenails, excluding patients with diabetes and/or paronychias. Fifty-eight patients underwent partial matrix excision, which included 5 to 10 mL of lidocaine 1%, according to the study. Fifty-one patients underwent orthonyxia via the Fraser procedure, which researchers say entails attaching a small metal brace to the dorsum of the nail.
The 12-month follow-up revealed four ingrown toenail recurrences in the partial matrix excision group and eight in the orthonyxia group. Both treatments were similarly effective, according to the study, but orthonyxia was superior when it came to aspects such as postoperative morbidity, recovery time, post-op symptoms and patient satisfaction.
For example, patients who had the orthonyxia procedure, on average, were able to wear shoes one day after the procedure, whereas patients treated with the partial matrixectomy were not able to wear shoes until four days after the procedure on average.

Does Orthonyxia Have A Role?
John Mozena, DPM, says orthonyxia is a not a new concept for ingrown toenail control. Several years ago, Dr. Mozena says there was a plastic brace that one could glue on the nail in an attempt to change the nail’s shape over time.
“I have not seen any brace that has worked well enough to stand the test of time,” notes Dr. Mozena, who is in private practice in Portland, Ore.
Alexander Reyzelman, DPM, has used orthonyxia and believes it has merit as a conservative option for treating ingrown toenails.
“Orthonyxia is indicated in patients who do not want or cannot have a surgical or chemical procedure due to peripheral vascular disease (PVD), etc.,” explains Dr. Reyzelman, an Assistant Professor and Chairman of the Department of Medicine at the California College of Podiatric Medicine at Samuel Merritt College. “If the patient has a first occurrence of the ingrown toenail without significant inflammation and would like to be treated conservatively, orthonyxia is a good choice.”

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