MNT Ingrown Toenail Management 2 — Questions and Answers
Question 1: Nail bracing (orthonyxia) for ingrown toenails works by:
- Chemically softening the nail plate
- Using a flexible composite or wire brace to flatten and realign nail curvature over time (Correct answer)
- Surgically resecting the lateral matrix
- Injecting corticosteroids into the nail fold
Correct answer: Using a flexible composite or wire brace to flatten and realign nail curvature over time
Nail braces apply outward force along the nail plate edges, gradually correcting involution and relieving pressure on the nail folds without surgery.
Question 2: The BS (Basis) brace system for ingrown nails requires the nail to be:
- Completely dry and unpolished before application
- Clean, dry, and filed smooth on the dorsal surface to ensure adhesion (Correct answer)
- Wet and pliable for best adherence
- Freshly lacquered for protection
Correct answer: Clean, dry, and filed smooth on the dorsal surface to ensure adhesion
The BS brace (a composite adhesive brace) requires the nail surface to be clean, dry, and gently filed to maximize adhesion and treatment efficacy.
Question 3: A patient with recurrent bilateral ingrown toenails despite conservative care is best managed by:
- Continuing cotton packing indefinitely
- Referral to a podiatrist for nail matrix phenolization or wedge resection (Correct answer)
- Daily antiseptic soaking only
- Prescription-strength emollients
Correct answer: Referral to a podiatrist for nail matrix phenolization or wedge resection
Chronic or recurring ingrown toenails that fail conservative management require definitive treatment such as partial matrix destruction (phenolization) by a qualified clinician.
Question 4: Hypergranulation tissue at the lateral nail fold of an ingrown toenail should be:
- Aggressively excised by the medical nail technician in all cases
- Documented, managed with silver nitrate or compression if within scope, and referred if extensive (Correct answer)
- Ignored until the patient requests treatment
- Cauterized with an open flame
Correct answer: Documented, managed with silver nitrate or compression if within scope, and referred if extensive
Hypergranulation tissue can be reduced with silver nitrate application or compression within the technician's scope; extensive or non-resolving cases require medical referral.
Question 5: Post-procedure instructions after nail edge elevation should include:
- Tight bandaging for 48 hours with no removal
- Keep the area clean and dry, change dressing daily, wear wide-toe footwear, and return if signs of infection develop (Correct answer)
- Apply talcum powder and avoid all moisture
- Immerse foot in hot water twice daily
Correct answer: Keep the area clean and dry, change dressing daily, wear wide-toe footwear, and return if signs of infection develop
Proper aftercare prevents infection and promotes healing; breathable dressings, daily inspection, appropriate footwear, and clear infection warning signs optimize outcomes.
Question 6: The Vandenbos procedure for ingrown toenails differs from partial nail avulsion in that it:
- Removes the nail plate entirely
- Excises the excess soft tissue (nail fold) rather than the nail, leaving the nail plate intact (Correct answer)
- Uses only topical anaesthesia
- Is performed using a laser only
Correct answer: Excises the excess soft tissue (nail fold) rather than the nail, leaving the nail plate intact
The Vandenbos procedure excises the hypertrophic nail fold tissue that impinges on the nail plate, correcting the problem without altering the nail itself.
MNT Ingrown Toenail Management 2
Nail bracing (orthonyxia) for ingrown toenails works by: