J R Soc Med. 2004 April; 97(4): 207. S Anari
Description of a procedure using silver nitrate cauterization of the nailfold

A.W.Fowler Br Med J. 1976 October 2; 2(6039): 815–816.

An ingrown nail (onychocryptosis) occurs when the edge of the toenail digs into, and pierces, the skin adjacent to the nail. The skin may present as inflamed, swollen and is almost always tender. Opportunistic infections can occur from the normal skin flora. Infection always exacerbates the lesion as further swelling gives rise to further pressure and a likelihood of increased penetration of the nail.

In this condition the nail burrows into the nail groove. The nail groove ulcerates and its wall grows over the nail. The nail becomes embedded.

It is being suggested that ingrowing toenails are increasing in incidence in people treated for fungal nail infections, with 19 of 100 needing surgery [2]. The message is that both avulsion with phenol and surgical excision of ingrowing toenails work. Nine out of 10 patients will have no symptomatic recurrence over six months or more. Combining the data from all the trials suggests that avulsion with phenol is statistically better than surgical excision, but one can see plenty of room for moving goalposts. The difference between the two techniques is small, and appropriateness will depend on local circumstances.

Onychocryptosis. An ingrown toenail is incurvation or im-pingement of a nail border into its adjacent nail fold, causing pain.
Merck Manual

Al Kline DPM Podiatry Internet Journal 1 (1): 11 History A 72 year old male presented in the hospital setting this week with a chief complaint of left “ingrown toenail”. He had a recent history of pain to the hallux and went to see his primary physician. He stated that one week prior, he began having pain to the hallux with an increase in “redness” to the toe. He was convinced he had an ingrown toenail, so he attempted to remove a portion of the nail without significant relief of symptoms.

Ingrown toenail is a common problem resulting from various etiologies including improperly trimmed nails, hyperhidrosis, and poorly fitting shoes. Patients commonly present with pain in the affected nail but with progression, drainage, infection, and difficulty walking occur. Excision of the lateral nail plate combined with lateral matricectomy is thought to provide the best chance for eradication. The lateral aspect of the nail plate is removed with preservation of the remaining healthy nail plate. Electrocautery ablation is then used to destroy the exposed nail-forming matrix, creating a new lateral nail fold. Complications of the procedure include regrowth of a nail spicule secondary to incomplete matricectomy and postoperative nail bed infection. When performed correctly, the procedure produces the greatest success in the treatment of ingrown nails. Basic soft tissue surgery and electrosurgery experience are prerequisites for learning the technique. (Am Fam Physician 2002;65:2547-50,2551-2, 2554,2557-8. Copyright© 2002 American Academy of Family Physicians.)

Journal of Bone and Joint Surgery - British Volume, 1984 Vol 66-B, Issue 1, 63-65 RM Antrum
A simple method of treatment for ingrowing toenail by radical excision of the affected nailfold is described. The results in a prospective series of 50 patients are presented. This procedure, first described in 1872, does not destroy the nail, which heals to give an excellent cosmetic result. The recurrence rate after 18 months was 20 per cent, which compares favourably with procedures in which the nailbed is ablated. This method is proposed as an alternative to more complex procedures, especially when a cosmetic result is desired.

At least 10% of Americans complain of some type of foot problem, leading to approximately 17 million physician visits yearly. Ingrown toenail, known medically as onychocryptosis, is the proximate cause of 20% of those physician visits.[1] While many patients choose to visit a physician for ingrown toenail, foot problems are the specialized domain of podiatrists, who possess an advanced degree designed for problems of the feet. In an average year, the typical podiatrist sees many more cases of ingrown toenail than do most physicians, and pharmacists should take this fact into account when referring patients for professional care.
US Pharmacist 28(4), 2003. Joshua J. Pray, Pharm.D. Candidate, W. Steven Pray, Ph.D., R.Ph.

Harvey V. Thommasen, MD, MSc, FCFP C. Stuart Johnston, MB ChB, MSc (Eng) Civil, CCFP Amy Thommasen, BSc(c) CJRM 2005;10(3):173-80
The ingrowing toenail is a painful foot condition that can be treated by most rural physicians. If it is not too severe, conservative management can be initiated first. If the situation is not improving or is worsening, removal of the nail plate with destruction of the nail matrix, by either surgical or chemical matricectomy, is indicated. Neither matricectomy technique is particularly complicated. Quick healing, minimal postoperative morbidity, high success rates and cosmetically acceptable results are the rule. Risks associated with the procedure include infection, chronic ulcer formation, pain, prolonged healing, irregular nail regrowth and recurrence. Patients should be aware of these risks before the matricectomy is performed.