Foot loading is different in people with and without pincer nails: a case control study

Deviation of the Nail Lamina after Unilateral Partial Matricectomy

Deviation of the nail plate in the transverse plane has traditionally been regarded as a postoperative complication following the definitive surgical treatment of ingrown toenails, particularly when only a single nail fold is addressed. The quantification and longitudinal comparison of the operated versus non-operated nail folds could elucidate potential transverse deviations of the nail plate. The objective of this study was to assess the presence or absence of transverse nail plate deviation following ingrown toenail surgery on a single nail fold.

METHODS

A cohort of 11 patients (three males, eight females) with recurrent ingrown toenails undergoing unilateral partial matricectomy were included in this study. Preoperative measurements were compared to those taken at 7, 14, 21, 28, and 35 days postoperatively.

RESULTS

The analysis revealed no statistically significant differences in measurements between the operated and non-operated nail folds, nor were there significant changes in the measurements over time within each group (p > 0.05).

CONCLUSIONS

Despite the absence of visible deviations in the orientation of the nail plate, the angular measurements post-surgery at 35 days showed no statistically significant alterations. The angular values observed across all time points appeared to be influenced by the intrinsic morphological characteristics of each nail plate.

Cross-sectional study of the prevalence of hyperextension of the first metatarsophalangeal joint and its relationship to onycholysis in women with hallux valgus

BACKGROUND

Hallux Valgus (HV) deformity is associated with misalignment in the sagittal plane that affects the first toe. However, the repercussions of the first toe hyperextension in HV have been scarcely considered. The purpose of this study was to provide evidence of the association between first-toe hyperextension and the risk of first toenail onycholysis in HV.

METHODS

A total of 248 HV from 129 females were included. The extension of 1st MTP joint was measured while the patient was in the neutral position of the hallux using a two-branch goniometer. The classification of the HV severity stage was determined by the Manchester visual scale, and the height of the first toe in the standing position was measured using a digital meter. An interview and clinical examination were performed to collect information on the presence of onycholysis of the first toe.

RESULTS

Of the 248 HV studied, 100 (40.3%) had onycholysis. A neutral extension > 30 degrees was noted in 110 (44.3%) HV. The incidence of onycholysis was higher in HV type C than in type B (p = 0.044). The probability of suffering onycholysis in the right foot was 2.3 times greater when the neutral position was higher than 30 degrees (OR = 2.3; p = 0.004). However, this was not observed in the left foot (p = 0.171). Onycholysis was more frequent in HV with more than 2 cm height of the first toe (p < 0.001). For both feet, the probability of suffering onycholysis was greater for each unit increase in hallux height (right foot OR = 9.0402, p = 0.005; left foot OR = 7.6633, p = 0.010).

CONCLUSIONS

The incidence of onycholysis appears to be significantly associated with HV showing more than 30º extension, and more than 2 cm height of the first toe. Height and hyperextension of the first toe together with first toenail pathology should be mandatory in the evaluation of HV.

Long-term results of nail correction with double wires for pincer nail deformity: A retrospective cohort study

There is no consensus on the best treatment for pincer nail deformity. We developed a novel procedure that uses double wires to treat pincer nail deformity on the great toe. This study aimed to describe this technique for pincer nail deformity treatment and present the long-term findings/observations. After injecting a local anesthetic, a mini router was used to make holes on both sides of the nail plate edge, and the wire was inserted in two places, one proximal and the other distal to the great toenail. The wire was removed when it moved to the tip of the great toe as the nail grew. Patients who underwent this method were evaluated retrospectively from 2014 to 2020. Patients with less than 24 months of follow-up were excluded. If pain occurred again, it was deemed as a recurrence. A total of 27 patients (36 toes, mean age: 69.5 years) were evaluated. In all cases, the pain disappeared 1 week after the procedure. In the correction period (mean 2.7 months), six toes had complications (nail break, four toes and nail hold pain, two toes), while recurrence occurred in four toes within 2 years. Curvature (nail tip height/width of nail tip × 100%) improved significantly up to 1-year post-procedure (37.7 ± 14.4%, p < 0.05) as compared to pre-correction (53.8 ± 24.7%). The procedure time was short (approximately 10 minutes), and the treatment was completed with a single procedure. In addition, the recurrence rate was low.

Terminal Syme Amputation of the Great Toe in the Pediatric Population

BACKGROUND

In the pediatric population, chronic ingrown toenails (onychocryptosis) can cause infection (paronychia), debilitating pain, and may be unresponsive to conservative treatments. Following multiple failed interventions, a terminal Syme amputation is one option for definitive treatment of chronic onychocryptosis. This procedure involves amputation of the distal aspect of the distal phalanx of the great toe with complete removal of the nail bed and germinal center, preventing further nail growth and recurrence.

METHODS

A retrospective review was performed to determine outcomes of a terminal Syme amputation in the pediatric population. Inclusion criteria included treatment of onychocryptosis involving terminal Syme amputation with a minimum follow-up of 1 year. The medical record was reviewed to assess previous failed treatment efforts, perioperative complications, radiographic outcomes, and the need for additional procedures.

RESULTS

From 1984 to 2017, 11 patients (13 halluces) with onychocryptosis were treated with a terminal Syme amputation. There were no intraoperative complications. One hallux had a postoperative infection requiring antibiotics as well as partial nail regrowth following the terminal Syme procedure that required subsequent removal of the residual nail. Following partial nail ablation, the patient had no further nail growth. An additional patient also developed a postoperative infection requiring oral antibiotic treatment. All patients returned to full weight-bearing physical activities within 6 weeks of surgery.

CONCLUSIONS

Terminal Syme amputation was successful in treating pediatric patients who have recalcitrant onychocryptosis and paronychia. There was little functional consequence following terminal Syme amputation of the great toe in this patient population, making it an effective salvage procedure.

LEVEL OF EVIDENCE

Level IV-retrospective comparative study.

Presence of a family history and excessive pressure on the first toe pad during walking in female subjects with pincer nails

Pincer nails (PN) are defined as a transverse overcurvature of the nail plate. Although there have been advancements in therapeutic approaches, the precise underlying mechanisms for the development of PN are still not fully understood. Currently, PN are assumed to develop due to lack of upward mechanical force on the toes. We developed a novel wireless device to observe detailed gait motion. We analyzed trends of gait motion in healthy individuals without PN, healthy individuals with PN without a family history of PN, and healthy individuals with PN and a family history of PN. We found that a family history of PN is an independent risk factor for PN, irrespective of gait motion. Moreover, healthy individuals with PN but without a family history of PN exhibit strong and concentrated pressure on the first toe pad during walking. In sum, a family history of PN and excess upward mechanical forces on the first toe pad during walking may be risk factors for the development of PN.

Intra and intersession repeatability and reliability of the S-Plate® pressure platform

AIM

The aim of this study was to assess the repeatability and reliability of the S-Plate® pressure platform in a group of healthy subjects.

MATERIAL AND METHODS

Forty subjects, free from physical conditions that would affect normal gait, walked along a five-meter corridor while data were recorded from the pressure platform. A total of 10 steps (five each side) were obtained as well as five static trials; the same measurements were repeated one week later. Peak and mean plantar pressures and contact area were recorded for both dynamic and static trials. Additionally, weight supported on each limb was documented during static trials. To assess intrasession and intersession repeatability and reliability, the intraclass correlation coefficients (ICCs) and coefficient of variation (CoV) were calculated.

RESULTS

Taking the ICC values into account, every static and dynamic variable analysed showed moderate to excellent reliability and the CoV values were all below 12%.

CONCLUSION

Measurements of either static or dynamic plantar pressure variables with the S-Plate® pressure platform show good repeatability and reliability, and so it is useful for comparing steps within and between sessions.