ONYCHOCRYPTOSIS

My child has a very painful toenail, what should I do?

– “Onychocryptosis”

La dolencia del aparato ungueal es unas de las dolencias más comunes en el pie y un motivo de consulta habitual. This affectation of the nail plate is called onychocryptosis, and consists of the nail becoming embedded in the adjacent soft tissues. The most commonly used term for this condition is “ingrown nail”. (1,2). (1,2)

What is the reason for this?

Onychocryptosisis multifactorial and can be due to both extrinsicfactors (microtrauma, footwear, inadequate nail cutting, poor hygiene, etc.) and intrinsic factors (genetic predisposition, malformation of the nail plate, biomechanical alterations, hyperhidrosis, presence of underlying bone pathology, digital deformities, systemic diseases, etc.). (1,3). (1,3)

How is it diagnosed?

The diagnosis is purely clinical and three degrees are differentiated; (4)

1. Initially the nail plate is compressed but does not penetrate into the adjacent soft tissues. Symptoms are erythema, oedema and pain.
2. The soft tissues react and produce a granuloma, resulting in pain and oozingin the nail sulcus.
3. Eventually, the nail plate is pushed into the distalsoft tissue, the granuloma is covered with epithelial tissue, there is intense pain on pressureand hypertrophyof the lateral wall.

The most affected areas are the external areas of the firsttoe of both feet, although it can also occur on any toe. (1,4) (1,4)

How is it treated?

The definitive treatment is surgical; these are painful processes that require anaesthesia and limitation of physical activity, as well as a probability of post-surgical infections, so it would only be indicated in severe cases of the disease.

In mild cases, conservativetreatmentwould be indicated, which is divided into palliative techniques (speculation; removal of the nail spicule embedded in the soft tissue) and techniques for re-education of the nail plate (metal and plastic orthonyxia, resin nails, cotton wool technique, plastic cannulas, dental floss). These are painless, uncomplicated techniques, although they are not definitive treatments, as most have long-term recurrence rates. (1,4) (1,4)

How can this be prevented?

Preventive measures that should be taken to avoid this pathology are the following: properly fitting shoes that leave enough space around the toes, keeping the feet clean and dry, trimming the toenails straight. (1) (1)

1. Fernández LL, Carballo L. Índice : 2019;

2. Palacios-López C, Fernández-De-Lara A. Onicocriptosis en niños Onychocryptosis. Acta Pediatr Mex [Internet]. 2019;40(3):166–9. Available from: https://ojs.actapediatrica.org.mx/index.php/APM/article/view/1813/1 137

3. Stoduto Charle M, Palomo López P. Onicocriptosis en Pediatría: estudio clínico del tratamiento conservador. Rev Int Ciencias Podol. 2014;8(2):83–9

4. Gioseffi ML, Giachetti A, Sánchez PL, De Freijo S, Sojo M. Onicocriptosis en pediatría: Tratamiento conservador y espiculotomía. Arch Argent Pediatr. 2010;108(3):244–6.