Management of ingrowing toenail

Sir I was surprised that the leading article by Murray (Br J Surg 1989; 76: 8834) did not mention ‘soft tissue’ operations for ingrowing toenail. The opinion that the skin rather than the nail is at fault is supported by evidence that the shape of the nail does not differ from that in age matched controls’, both groups showing considerable variation in nail curvature and axis deviation. As [he nail does not appear to be abnormal, operations have been devised to treat the soft tissue abnormality, aiming to give a better cosmetic and functional result. Radical excision of the nailfold, as described by Antrum2, gave an 80percent cure rate. Subsequently, in a controlled trial, it produced only two recurrences in 32 treated toes3. This operation is quick and simple to perform, and does not disturb the nail or nail bed. It is very suitable for use by junior surgical trainees, to whom toenail surgery is often delegated. Its only disadvantage is that full healing takes an average of 5 weeks. The cosmetic result is excellent -indistinguishable from a normal toe.