Patient-Controlled Taping for the Treatment of Ingrown Toenails

Ingrown toenails occurs when the nail fold is traumatized by the nail plate. Ingrown toenails occur in up to 20% of patients visiting family physicians with foot problems.[1] Different methods of treatment (taping, packing, gutter, brace, hygienic measures, and surgical procedures) have been described for treatment of an ingrown toenail.[2] Management options can be chosen based on the stage of the ingrown nail or structure of nail edge (normal nails vs. abnormally wide or curved).[3] Many patients prefer conservative methods over surgical treatments; conservative approaches are more cost effective, do not have the contraindications of surgical treatment, and are reasonable initial treatments for mild to moderate cases.[1]

Taping has been described as one of the least invasive ingrown nail treatments. Taping is done to pull the traumatized lateral nail fold away from the nail plate edge in mild cases.[2] There is a paucity of literature about taping methods. Tsunoda et al published an interesting retrospective observational study on 750 ingrown nails. Of these, 88 had previous surgery. They used a mesh elastic adhesive tape of 25 mm in width and about 35 mm in length. With one end of the tape attached along the lateral nail fold, the first 1cm of the tape was stretched toward the plantar surface and the residual part of the tape was fixed in the plantar surface without any stretch. The stretch of webbed tape seems to provide a force toward the center of stretched part, pulling the nail fold and wound away from the nail plate promoting wound healing [4] (Figure 1). [annfammed.org/site/misc/TRACK/AliniaTableFigure.doc]

After two month follow up of treatment, the response rate was higher among 662 patients who did not have previous surgery compared to those had surgery before (47.7% vs. 20.4%).[4] By not completely encircling the toe with tape, there was less skin irritation, joint movement restriction and circulation problem expected than conventional taping method. The study and treatment method did have some limitations (Table 1). [annfammed.org/site/misc/TRACK/AliniaTableFigure.doc]

To better define how effective this approach is, it would help to have a randomized controlled study for mild to moderate cases compared with a "no treatment" or other conservative treatment as a control group, comparing the improvement rate, satisfaction and the quality of life with longer follow up period.

References:
1. Heidelbaugh JJ, Lee H. Management of the ingrown toenail. Am Fam Physician. 2009 Feb 15;79(4):303-8.
2. Haneke E. Controversies in the treatment of ingrown nails. Dermatol Res Pract. 2012;2012:783924. doi: 10.1155/2012/783924. Epub 2012 May 20.
3. Park DH, Singh D. The management of ingrowing toenails. BMJ. 2012 Apr 3;344:e2089. doi: 10.1136/bmj.e2089.
4. Tsunoda M, Tsunoda K. Patient-controlled taping for the treatment of ingrown toenails. Ann Fam Med. 2014 Nov-Dec;12(6):553-5. doi: 10.1370/afm.1712.
5. Taheri A, Mansoori P, Alinia H, Lewallen R, Feldman SR. A Conservative Method to Gutter Splint Ingrown Toenails. JAMA Dermatol. 2014 Dec 1;150(12):1359-1360. doi: 10.1001/jamadermatol.2014.1757.

Hossein Alinia MD [1], Arash Taheri MD [1,2] and Steven R. Feldman MD, PhD [1,3,4]
Wake Forest University School of Medicine
1. Center for Dermatology Research, Department of Dermatology
2. Department of Internal Medicine
3. Department of Pathology
4. Department of Public Health Sciences

Competing interests: Hossein Alinia and Arash Taheri have no conflict of interest to disclose. Dr. Feldman is a speaker for Janssen and Taro. He is a consultant and speaker for Galderma, Stiefel/GlaxoSmithKline, Abbott Labs, Leo Pharma Inc. Dr. Feldman has received grants from Galderma, Janssen, Abbott Labs, Amgen, Stiefel/GlaxoSmithKline, Celgene and Anacor. He is a consultant for Amgen, Baxter, Caremark, Gerson Lehrman Group, Guidepoint Global, Hanall Pharmaceutical Co Ltd, Kikaku, Lilly, Merck & Co Inc, Merz Pharmaceuticals, Mylan, Novartis Pharmaceuticals, Pfizer Inc, Qurient, Suncare Research and Xenoport. He is on an advisory board for Pfizer Inc. Dr. Feldman is the founder and holds stock in Causa Research and holds stock and is majority owner in Medical Quality Enhancement Corporation. He receives Royalties from UpToDate and Xlibris.