Efficacy of Conservative Nail Gutter Splint Treatment for Ingrown Toenail

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Authors (including presenting author) :
Kwok YK (1)
Affiliation :
(1)Podiatry Department, Queen Mary Hospital
Introduction :
Ingrown toenail (IGTN), also known as onychocryptosis, is one of the most commonly treated cases in daily podiatric clinic. It is an ordinary pathology of foot that occurs in all age groups which may happen in every generation especially of high incidence rate for the youth and elderly due to poor self-care; age or disease related deformed toenails problems (Heidelbaugh and Lee, 2009). Current conservative treatments for IGTN is of high deviation of efficacy due to dependence on patient’s self-care. Nail gutter splint treatment is a conservative treatment that does not require patient’s intervention. It aiming at allowing symptoms free nail regrow by the means of tunnel. It is a relatively new treatment in Hong Kong without any local evidence support to author’s knowledge. A 12 weeks nail gutter splint treatment program was designed by author to evaluate its outcome and safety. Program consisted of 4 clinical visits for placement of nail gutter splint, which did not involve any surgical intervention nor local anesthesia administration.
Objectives :
To evaluate the efficacy of conservative nail gutter splint treatment and determine its suitability for use of high risk patients suffering from IGTN in hospital setting.
Methodology :
25 subjects with onychocryptosis were recruited according to sets of inclusion and exclusion criteria. Efficacy was evaluated by both objective measurement included healing status and recurrence by author; and subjective measurement included VAS and patients’ satisfaction by questionnaire. IBM SPSS Version Statistics (SPSS Inc., Chicago, Illinois) was used for data collection, statistical calculation and analysis. Paired sample t-tests was used to calculate the difference of VAS before and after the procedure. P-value < 0.05 was considered as statistically significance. The study was under the surveillance of the Institutional Review Board of The University of Hong Kong / Hospital Authority Hong Kong West Cluster, and ethical approval was granted.
Result & Outcome :
78.3% subjects were suffered from multiple diseases that required regular medical follow-up, whose were the target participants of conservative IGTN treatment. 86.96% onychocryptosis healed after first gutter splint treatment, all onychocryptosis healed within the 12 weeks’ program. The average healing time was 2.78 weeks. No recurrence of onychocryptosis reported at 3 months’ follow-up post 12 weeks’ program. The reduction of mean VAS in terms of toenail pain, walking pain and wearing shoes pain were all significant with p< 0.05. There were also significant immediate pain relief, continuous relieve of symptoms throughout the 12-week program, and improvement of symptoms post treatments (p< 0.05). All subjects were satisfied with the nail gutter splint treatment received. No complications reported in this study. Hence, it is concluded that conservative nail gutter splint treatment was of high efficacy and safe to practice on high risk patients in hospital setting.

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