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By Michelle Lin
Medical Doctor
Specialty: Emergency Medicine
Blog: http://academiclifeinem.blogspot.com
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Michelle Lin's Twitter Updates

@precordialthump I totally forgot about the EKG library! Awesome stuff. Keep up the great work (when do you sleep?!) 258 days ago
@emeducation Perfect, thanks for the suggestions! Turns out one is co-authored by Jeff Tabas. He already gave them all books. 258 days ago
Recommendations for an EKG resource to review bread & butter cases for senior residents? Pre-graduation panic setting in for our residents. 258 days ago
@danipedia Good point. I use the studies to convince the trauma consults NOT to get c-spine imaging on EVERYONE (citing distracting injury)! 263 days ago
@doctorflash Hi there. Just wanted to drop a note to thank you for all the extra traffic you're sending to blog. Much appreciated!! 273 days ago
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New guest blogger: Dr. Stella Yiu!

Posted Sep 22 2010 12:00am

It is 4 a.m.
You pick up a chart.
Toe pain.

Thinking this could be an easy injury, you walk over to the patient, only to discover: bilateral ingrown toenails. Your heart sinks. In your head, you are thinking: Lateral nail resection? Nail removal? This could take a while.

Is there a less invasive method for treating an ingrown toenail?
Trick of the Trade: Toenail splinting
The referenced article describes splinting the toenail, essentially lifting the offending edge of the toenail so subsequent growth does not push into the tissue.
  1. Anesthetize the toe either by topical anesthetic or by nerve blocks (not always necessary for mild cases).
  2. Excise nail sulcus using the tip of a curved hemostat to provide space. See photo above.
  3. Roll a 2-3 cm wisp of cotton saturated with alcohol to form a cylinder.
  4. Tuck the cotton into the nail sulcus, gently tucking it under the lateral free edge of the nail. This will keep the nail lifted during subsequent growth. Can also use a curved hemostat for this step.
  5. Patients should keep splints on for up to 3 months until the offending corner of nail grows past the distal edge of the lateral nail fold. Do not trim nails. Patients can repeat this process if the cotton falls out.
Variations:
Steri-strips or dental floss can also be used.

What I found:
This works great. Most times patients do not need nerve blocks and tolerate it well. I know colleagues who use this technique on their own toes!

Reference
Pottie K, Dempsey M, & Czarnowski C (2003). Practice tips. Toenail splinting. Canadian family physician Medecin de famille canadien, 49, 1451-3 PMID: 14649982

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