Baylor University Medical Center Proceedings April 2014, Volume 27, Number 2 | Page 71
Ingrown toenails (unguis incarnatus): nail braces/bracing
treatment
Anca Chiriac, MD, PhD, Caius Solovan, MD, PhD, and Piotr Brzezinski, MD, PhD
Nail bracing is a safe, simple, and inexpensive treatment option that
avoids surgery, requires no anesthetic, requires no recovery period, allows wearing the existing shoes, offers immediate relief from pain, and
allows the practice of daily activities. Braces can be used for prolonged
periods of times. If recurrence occurs, reapplication of bracing is usually
required.
ngrown toenails are one of the most frequent nail disorders,
with great impact on daily activities, discomfort, and pain.
Its pathogenesis is simple: a wide, curved nail plate associated with lateral corners cuts obliquely, leaving a tiny spicule
(a small piece of nail) that digs into the lateral nail groove and
pierces the epidermis. The result is a foreign body reaction with
inflammatory cells, granulation tissue, and secondary infection
(1). Candida albicans is a frequent complicating factor in both
the causation of an ingrown nail as well as its management.
Precipitating factors are narrow pointed shoes, tight socks, hyperhidrosis, and diabetes mellitus (2). There are three stages of
an ingrown nail: 1) inflammation, swelling, and pain; 2) inflammation, pain, nonhealing wound and oozing, and granulation
tissue; and 3) abscess formation and chronic induration of the
lateral nailfold. The treatment is frustrating and difficult for the
patients and physicians and is associated with local complications and sometimes permanently distorted toes and nails.
Nail braces were created in 1872 by E. E. Stedman, but
their use began in Europe and Australia in 1960. Ingrown toenail bracing was developed in the 1980s by the Institute for
Orthonyxia in Erlangen, Germany. Nail bracing is a conservative method used for ingrown nails, applied even in children,
patients with diabetes mellitus, and cases of local infection (stage
3). The braces are made from steel wire or plastic bands; the
wire is applied over the dorsal surface of the nail and curved
under its lateral edges (Figure) (3). A loop bridges the levers
and draws them together. The wires are then trimmed and the
edges covered with an artificial nail mass to protect footwear.
The braces are applied after measuring the nail of the individual,
and the pressure is modified monthly based on the presence of
symptoms. The administration of antibiotics is controversial,
and most favor simple hygienic measures. Braces are removed
when all symptoms vanish.
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Proc (Bayl Univ Med Cent) 2014;27(2):145
Figure. Nail brace treatment for an ingrown nail in an active athlete.
1.
2.
3.
Brzezinski P. Assessment of the effectiveness of application antiseptics in
prevention of foot skin inflammation. N Dermatol Online 2011;2(1):21–
24.
Brzezinski P. Skin disorders of the foot during military exercise and their
impact on soldier’s performance. Lek Wojsk 2009;87(2):80–83.
Talwar A, Puri N. A study on the surgical treatment of ingrowing toe nail
with nail excision with chemical matricectomy versus nail excision alone.
Our Dermatol Online 2013;4(1):32–34.
From the Department of Dermatology, Nicolina Medical Center, Iasi, Romania
(Chiriac); Department of Dermatology, Victor Babes University of Medicine,
Timisoara, Romania (Solovan); and Department of Dermatology, 6th Military
Support Unit, Ustka, Poland (Brzezinski).
Corresponding author: Piotr Brzezinski, MD, PhD, Department of
Dermatology, 6th Military Support Unit, os. Ledowo 1N, 76-270 Ustka, Poland
(e-mail: [email protected]).
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