Spiculectomy and Orthonyxia for Ingrown Toenails in Patients at Risk; Prospective Observational Cohort Study

Research Article

Foot Ankle Stud. 2021; 3(1): 1019.

Spiculectomy and Orthonyxia for Ingrown Toenails in Patients at Risk; Prospective Observational Cohort Study

Rosien L1,2*, van Dijk PR1,3,4, Oskam J5, Groenier KH1, Gans ROB4, Bilo HJG1,4 and Landman GWD6,7

1Diabetes Centre, Isala, Zwolle, The Netherlands

2Innofeet, Zwolle, The Netherlands

3Department of Endocrinology, University of Groningen, The Netherlands

4Department of Internal Medicine University of Groningen, The Netherlands

5Department of surgery, Isala, Zwolle, The Netherlands

6Medical Research Group Langerhans, Ommen, The Netherlands

7Department of Internal Medicine, Gelre Hospital, The Netherlands

*Corresponding author: Leonie Rosien, Diabetes Centre Isala, Mondriaan gebouw, Deenweg 1, 4th floor; 8025 BP Zwolle; The Netherlands

Received: December 21, 2020; Accepted: January 21, 2021; Published: January 28, 2021


Background: Ingrown toenails (unguis incarnatus) are common in persons with Diabetes Mellitus (DM) and Peripheral Arterial Disease (PAD). Minimal invasive treatment of ingrown toenails with spiculectomy and/or orthonyxia might be a promising treatment option.

Aim: The aim of this study was to evaluate the efficacy and safety of minimal invasive treatment spiculectomy and orthonyxia

Design/Setting: Prospective observational cohort study in an outpatient podiatric clinic

Method: Eighty-eight patients with unguis incarnatus were included. Primary outcomes were post-procedural complication rate (infection and hemorrhage), and duration of pain. Patient satisfaction during and after treatment procedure was evaluated.

Results: Healing was achieved in 80/88 (90.9%) persons; non-DM group 28/32 (87.5%) vs DM group 51/56 (91.1%); median healing time (21 [14, 42] days) and median treatment time; (56 [30, 86] days) were comparable between the non-DM and the DM groups. (Sixty-four patients (72.7%) had a significant pain reduction within 0-2 days. Median reduction of the VAS score after the first treatment was 2.0 points [0.0, 6.0] (non-DM group 3.5[1.0, 6.0]; DM group 2.0[0.0, 5.0] (p=0.0117)). Forty-eight (94, 4%) patients, 31(96.9%) non-DM group vs 53(94.6%) DM group (p=0.534)) had no limitations in daily activities by the affected toe after 14 days. There were no treatment-related complications like bleeding or infection.

Conclusion: Spiculectomy and orthonyxia resulted in a high patient satisfaction. Five of 88 patients needed referral for a partial nail resection. This treatment seems to be very suiTable for persons with a high risk for foot ulcerations.

Keywords: Orthonyxia; Spiculectomy; Unguis incarnates; Ingrown toenail; Diabetic foot


DM: Diabetes Mellitus; PAD: Peripheral Arterial Disease; IWGDF: International Working Group of the Diabetic Foot; VAS: Visual Analogue Scale; ABI: Ankle Brachial Index; TP: Toe Pressure; GP’s: General Practitioners; MODY: Maturity Onset Diabetes of the Young



Unguis incarnatus (ingrown toenail) is a highly prevalent condition with a prevalence of 54 per 10.000 persons per year in Dutch general practice [1]. Persons with Diabetes Mellitus (DM), especially those with neuropathy and/or Peripheral Arterial Disease (PAD), are at increased risk of developing unguis incarnates [2] and prone to develop complications, such as subungual ulcers with impaired healing and/or infection [3]. This is emphasized in the current guidelines, urging treatment of unguis incarnatus as if it is a pre-ulcerative sign and risk of amputation [4]. Depending on the presence of pain, drainage, inflammation and granulation tissue, unguis incarnatus is classified into 3 stages (Table 1), [1]. For patients with stage 1 conservative treatment is recommended [5]. Nail matrix excision and application of phenol is the advised treatment option in stages 2 and 3 [1, 6]. In persons with increased risk for foot complications, such as DM and PAD, there are complication risks with nail matrix excision and phenol application; therefore these patients have been often excluded from studies on effectiveness of phenol matricectomy [7].