Ingrown Toenail

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍ingrown toenail

Location is on ‍rightleft ‍big toesecond toethird toefourth toelittle toe

Symptoms include:

‍pain

‍swelling

‍redness

‍purulent discharge

‍pus-filled abscess

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills



Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍improper nail trimming

‍tight-fitting shoes

‍recent trauma to the nail

‍pedicures

no history of: ‍thick nail, ‍ingrown toenail, ‍diabetes, ‍peripheral arterial disease, ‍immunodeficiency





EXAM:

Toe: ‍rightleft ‍1st2nd3rd4th5th: ‍tenderness on ‍, range of motion ‍fulllimited





ASSESSMENT:

‍Ingrown toenail ‍likelysuspectedpossible

DDx: ingrown toenail, paronychia, toe infection, cellulitis, onychomycosis, foreign body reaction, gout, psoriasis, contact dermatitis, squamous cell carcinoma, osteomyelitis, diabetic foot ulcer





PLAN:

Nail avulsion:

- Type: ‍partialtotalradical

- Consent: informed of potential risks including infection, pain, bleeding, and recurrence

- Preparation: area cleaned with ‍betadinechlorhexidine

- Anesthesia: ‍lidocaine ‍ cc ‍locallydigital block

- Procedure: toenail avulsion performed

- Tolerance: ‍well tolerated

- Instructions: keep area clean, apply antibiotic ointment, and change bandage daily

Treatments:

- ‍Antibiotics

- ‍Analgesics

- Warm soaks in Dakin's solution

- Avoid tight shoes

- Avoid cutting nails too short

Further care:

- Referral to podiatrist

- Referral to surgeon

- Follow-up in ‍ ‍weeksmonths

- Return if redness expands, fever develops, or if new symptoms occur such as pus or increased pain