from greek: (onyx, "nail") + (kryptos, "hidden) which
means the nail grows into the nailbed. One of common form of nail diseases. ETIOLOGY Improper debridement by the patient can lead to ingrown nails. Ill-fitting shoes may also be a causative factor. The presence of a subungual exostosis has been stated to be the pathogenesis. Excess soft tissue growing. Hypermobility of the first metatarsal segment and hallux valgus. Trauma to the nail matrix or nail bed. CLINICAL MANIFESTATION Discomfort Pain Crusting, purulence, and friable granulation tissue. PHYSICAL EXAMINATION Upon examination, the following may be present: Edema or inflammation of tissue surrounding the nail bed Erythema of the same tissue Macerated or friable granulation tissue Crusting Drainage Hypertrophy of the nail margin Hypertrophy of the surrounding epidermis CLASSIFICATIONS & STAGES Symptomatic or non-symptomatic ( infected or non-infected) Stage 1: Mild erythema edema and pain with pressure Stage 2: Significant erythema, edema, local infection, and discharge Stage 3: Granulation tissue formation and hypertrophy of the lateral wall besides the significant erythema, edema, and discharge TREATMENT & MANAGEMENT Medical care -> conservative management used in ingrown nails stage 1 General Measures: - Use well fitted shoes - Trim toe nails properly - Manage underlying possible predisposing factors such as onychomycosis and hyperhidrosis. - Soak the affected toe in warm water, followed by application of topical antibiotics or silver nitrates in case there is granulation tissue. CONSERVATIVE METHODS COTTON WICK Cotton wick insertion in the lateral groove corner is one method. Using a nail elevator or small curette, small wisps of cotton are inserted under the lateral edge of the ingrown nail. Symptomatic improvement was reported in 79% of patients in a case series with mean follow up of 24 weeks. TOE TAPING he affected toe is taped in a way that the one end of the tape is placed on the side of the ingrown nail along the granulation tissue and twisted around the toe at an angle, with the other end overlapping the first without covering the wound itself. This taping allows drainage of accumulated pus, drying of the wound, and decreasing the pressure on the nail bed. NAIL SPLINTING Nail splinting by flexible tube (gutter treatment) involves a small sterilized vinyl intravenous drip infusion tube, which is cut and slit appropriately from top to bottom with one end cut diagonally for smooth insertion. The lateral edge of the affected nail plate is splinted with this tube under local anesthesia. The plastic tube is then covered by adhesive or wound closure strips and the patient is instructed to wash his or her toe daily with povidone iodine solution for 3-4 weeks. This method allows the nail spicule to grow without injuring the nail fold, and the inflammatory process will subside. The split tape-strap technique is a procedure that involves elastic tape cut into pieces about 3 cm wide and about 10 cm long, folded longitudinally in half. A slit is then created on the width of the ingrown nail along the short edge of one third of the tape length. The ingrown nail is then inserted in the slit, orienting the tape with the shorter side of the tape towards the dorsal side of the toe and hooking the slit edge of the longer side on the ingrown nail and attaching it to the plantar surface of the toe. This procedure showed favorable results as monotherapy or when combined with other conservative procedures. SURGICAL CARE Complete nail evulsion Partial nail evulsion Wedge matrix excision Partial matrix excision Total matrix excision Vandenbos procedure GANGLION CYST DEFINITION Ganglion cysts are noncancerous lumps that most commonly develop along the tendons or joints of your wrists or hands. They also may occur in the ankles and feet. Ganglion cysts are typically round or oval and are filled with a jellylike fluid. CAUSES The cause of these cysts is unknown although they may form in the presence of joint or tendon irritation or mechanical changes. They occur in patients of all ages. These cysts may change in size or even disappear completely, and they may or may not be painful. These cysts are not cancerous and will not spread to other areas. SYMPTOMS The lumps associated with ganglion cysts can be characterized by: Location. Ganglion cysts most commonly develop along the tendons or joints of your wrists or hands. The next most common locations are the ankles and feet. These cysts can occur near other joints as well. Shape and size. Ganglion cysts are round or oval and usually measure less than an inch (2.5 centimeters) in diameter. Some are so small that they can't be felt. The size of a cyst can fluctuate, often getting larger when you use that joint for repetitive motions. Pain. Ganglion cysts usually are painless. But if a cyst presses on a nerve even if the cyst is too small to form a noticeable lump it can cause pain, tingling, numbness or muscle weakness. DIAGNOSIS Trans-illumination test : the light will often pass through these lumps X-ray TREATMENT Ganglion cysts are often painless, requiring no treatment. Your doctor may suggest a watch-and-wait approach. If the cyst is causing pain or interfering with joint movement, then we can do these : Immobilization. Because activity can cause the ganglion cyst to get larger, it may help to temporarily immobilize the area with a brace or splint. As the cyst shrinks, it may release the pressure on your nerves, relieving pain. Avoid long- term use of a brace or splint, which can cause the nearby muscles to weaken. Aspiration. In this procedure, your doctor uses a needle to drain the fluid from the cyst. The cyst may recur. Surgery. This may be an option if other approaches haven't worked. During this procedure, the doctor removes the cyst and the stalk that attaches it to the joint or tendon. Rarely, the surgery can injure the surrounding nerves, blood vessels or tendons. And the cyst can recur, even after surgery. LIFE STYLE & HOME REMEDIES Analgesic ( ibuprofen, naproxen, diclofenac) An old home remedy for a ganglion cyst consisted of "thumping" the cyst with a heavy object. This isn't a good solution because the force of the blow can damage surrounding structures in your hand or foot Also don't try to "pop" the cyst yourself by puncturing it with a needle. This is unlikely to be effective and can lead to infection.