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Infantile bilateral ingrown toe nails: A case report from sub-saharan Africa
Isaac Oluoch Kobe1, Nathan Wafula Khamalla2
1Senior Resident, The Aga Khan University Hospital, Surgery Department, Nairobi, Kenya
2Consultant Orthopaedic Surgeon, Surgery Department, The Aga Khan University Hospital, Nairobi, Kenya

Article ID: 100899Z01IK2018
doi: 10.5348/100899Z01IK2018CL

Corresponding Author:
Dr. Isaac Oluoch Kobe,
P.O. Box 58605-00200, Nairobi, Kenya

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Kobe IO, Khamalla NW. Infantile bilateral ingrown toe nails: A case report from sub-saharan Africa. Int J Case Rep Images 2018;9:100899Z01IK2018.


CASE REPORT

The patient was a 2-year-old male who was brought in by his parents with complaint of irritability and pain on crawling and manifested by crying excessively. He was otherwise well with unremarkable past medical history and milestones were up to date. Examination revealed bilateral ingrown hallux nails which elicited tenderness on palpation. The infant underwent wedge excision and sharp matricectomy under general anaesthesia and was discharged the following day for regular wound dressings. He showed satisfactory recovery with subsequent reviews in the orthopaedic clinic revealing no early recurrence (Figure 1).

Keywords: Hallux, Ingrown toe nails, Wedge excision



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Figure 1: Patient with bilateral infantile ingrown toe nails.


DISCUSSION

Ingrown toe nails are more common in older children and adults [1]. Much has been documented on the therapy but little on the pathoanatomy causing the condition. Baran et al has reported malalignment of the nail apparatus as an aetiology in their analysis of thirty patients. In this condition, the nail plate is deviated lateral to the longitudinal axis of the distal phalanx. Correction of this deformity, a congenital malalignment, is suggested to avert subsequent ingrowing and hemionychogryphosis which is one of its long term sequale [1]. Other theories of causation suggest improper cutting of nails in convex fashion and presence of paronychia as a result of sucking. More scientific early explanations including Lathrops theory suggest that it results from imbalance between the borders of the nail and cuticle due to incurving of the medial borders resulting from inherited architecture [2], [3]. Treatment includes conservative treatment for patients with mild lateral deviation of the nail plate with follow up podiatry examination to detect complications [4]. Surgical realignment is often required for individuals with either marked nail plate deviation or disabling sequelae.


CONCLUSION

Infantile ingrown toe nails are a rare condition but patients require adequate recognition and treatment to avert discomfort as a result of this morbidity.


REFERENCES
  1. Baran R, Bureau H. Congenital malalignment of the big toe-nail as a cause of ingrowing toe-nail in infancy: Pathology and treatment (a study of thirty cases). Clin Exp Dermatol 1983 Nov;8(6):619–23.   [CrossRef]   [PubMed]    Back to citation no. 1
  2. Bailie FB, Evans DM. Ingrowing toenails in infancy. Br Med J 1978 Sep 9;2(6139):737–8.   [CrossRef]   [PubMed]    Back to citation no. 2
  3. Lathrop RG. Ingrowing toenails: Causes and treatment. Cutis 1977 Jul;20(1):119–22.   [PubMed]    Back to citation no. 3
  4. Grassbaugh JA, Mosca VS. Congenital ingrown toenail of the hallux. J Pediatr Orthop 2007 Dec;27(8):886–9.   [CrossRef]   [PubMed]    Back to citation no. 4

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Author Contributions
Isaac Oluoch Kobe – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Nathan Wafula Khamalla – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of Submission
The corresponding author is the guarantor of submission.
Source of Support
None
Consent Statement
Written informed consent was obtained from the patient for publication of this study.
Conflict of Interest
Author declares no conflict of interest.
Copyright
© 2018 Isaac Oluoch Kobe et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.