Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
  • LinkedIn
  • Instagram
Research ArticlePractice

Ingrown toenail or overgrown toe skin?

Alternative treatment for onychocryptosis

Henry Chapeskie
Canadian Family Physician November 2008; 54 (11) 1561-1562;
Henry Chapeskie
Medical practitioner at the Thorndale Lion’s Medical Centre in Thorndale, Ont, and an Adjunct Professor in the Department of Family Medicine at the University of Western Ontario in London
MD CCFP FCFP
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • CFPlus
  • eLetters
  • Info & Metrics
  • PDF
Loading

There are currently many surgical options for treating the “ingrowing toenail” (for example, wedge resection, which is demonstrated in this month’s Video Series); however, they tend to have high rates of recurrence, poor cosmetic results, and low rates of patient satisfaction.1 According to a 2005 Cochrane Review, rates of regrowth after the long-standing treatment (phenolization) were 34% for GPs and 50% for general surgeons.1 In 1959, Vandenbos and Bowers noted that patients who developed this problem tended to have an excessive amount of tissue at the sides of the affected nail. They theorized that weight-bearing caused the tissue to bulge over the sides of the nail, resulting in pressure necrosis.2 The Vandenbos procedure (described below) took form based on this theory and now challenges the current paradigm.

Indications

The Vandenbos procedure is indicated for patients with classic onychocryptosis, most of whom are in their second or third decade of life. It is not recommended for patients with dystrophic nails, fungal infections, or thick, discoloured, curling nails, as seen in the elderly.

Materials

The following materials are required to perform the Vandenbos procedure:

  • alcohol swab,

  • tourniquet,

  • 3 mL of 2% xylocaine with a 25-gauge 1-inch needle,

  • iodine solution,

  • scalpel with a No. 15 blade,

  • tissue forceps,

  • hyfrecator,

  • tulle gauze,

  • 2 x 2-inch gauze, gauze roll, and tape.

Procedure

A video of the procedure is available on CFPlus* and at www.ingrowntoenails.ca. The instructions for this procedure are as follows:

  1. To begin, a ring block is done at the base of the toe with 3 mL of plain 2% xylocaine (1.5 mL per side), and a tourniquet (eg, a Penrose drain) is wrapped tightly around the toe. The toe is cleaned with an iodine wash.

  2. A 5 mm incision is made proximally from the base of the nail, about 3 mm from the edge (leaving the nail bed intact). The incision should extend toward the side of the toe in an elliptical sweep and finish under the tip of the nail, still keeping to 3 mm from the edge. It is important that all skin at the edge of the nail be removed. The excision must be generous and adequate, leaving a soft tissue deficiency of about 1.5 x 3 cm (Figure 1).

    If the physician is apprehensive and does not remove an adequate amount of soft tissue, the problem might recur. A portion of the lateral aspect of the distal phalanx is occasionally exposed without fear of infection. Antibiotics are unnecessary—the wound is left open to heal by secondary intention. Vandenbos and Bowers reported no cases of osteomyelitis in their study.2

  3. Light cauterization with a hyfrecator along both the edge of open skin and the subcutaneous tissue of the wound reduces postoperative bleeding and pain. Do not damage the nail bed or matrix as this is a nail-sparing procedure.

  4. A fine mesh tulle gauze (10 cm2) is folded and placed directly over the wound. A snug dressing is applied (eg, a roll of 5-cm gauze wrap). The elastic tourniquet is then removed. Keep the foot elevated to help minimize bleeding.

  5. Once at home, the patient should lie down with the foot elevated for the first 1 to 2 days. Analgesia should be achieved using acetaminophen with codeine (eg, Tylenol No. 3) and ibuprofen.

  6. About 48 hours after the operation, the patient should soak the foot in warm water with 1 to 2 tbsp Epsom salt for 20 minutes, gradually removing the dressing. It is common for minimal bleeding to occur. After soaking, a small dressing should be applied to the wound. This procedure must be diligently repeated 3 times daily while the wound gradually heals inward from the periphery, as it aids the healing and keeps the wound clean. There will naturally be some redness around the wound for 1 to 2 weeks postoperatively; however, antibiotics are not necessary.

  7. Patients return for follow-up after 2 weeks to ensure that adequate healing and proper care of the wound is taking place. At 4 to 6 weeks the wound should be healed with the nail above the skin (Figure 1).

Figure 1
  • Download figure
  • Open in new tab
Figure 1
  • Download figure
  • Open in new tab
Figure 1
  • Download figure
  • Open in new tab
Figure 1
  • Download figure
  • Open in new tab
Figure 1
  • Download figure
  • Open in new tab
Figure 1 The Vandenbos procedure, pre- to postoperatively

A) Preoperative toe; B) and C) intraoperative toe; D) and E) healed toe, 4 to 6 weeks following procedure.

Discussion

Over the past 20 years, I have performed this procedure on more than 500 toes in 440 patients and have had no recurrences or cases of osteomyelitis. Other studies of this procedure report similar results.2,3 As Vandenbos and Bowers directly state, “the term ingrown toenail is unfortunate in that it incriminates the nail as the causative factor and is responsible for the fact that most operative and conservative treatments are directed towards the nail.”2 In support of Vandenbos’s theory, results of a prospective study measuring the nails of patients with ingrowing toenails and comparing them with those of controls “failed to demonstrate any abnormality of the nail … suggest[ing] that treatment should not be based on the correction of a nonexistent nail deformity.”4

The Vandenbos procedure is a rational physiologic approach to the problem of overgrown toe skin (onychocryptosis) and yields a curative, cosmetically excellent result. Not surprisingly, patient satisfaction reflects this.

For more information, visit www.ingrowntoenails.ca for access to research articles, physician and patient information, photo galleries, and a video of the Vandenbos procedure.

Footnotes

  • Competing interests

    None declared

  • We encourage readers to share some of their practice experience: the neat little tricks that solve difficult clinical situations. Praxis articles can be submitted on-line at http://mc.manuscriptcentral.com/cfp or through the CFP website www.cfp.ca under “Authors.”

  • Copyright© the College of Family Physicians of Canada

References

  1. ↵
    1. Rounding C,
    2. Bloomfield S
    . Surgical treatments for ingrowing toenails. Cochrane Database Syst Rev 2005;(2):CD001541.
  2. ↵
    1. Vandenbos KQ,
    2. Bowers WF
    . Ingrown toenail: a result of weight bearing on soft tissue. U S Armed Forces Med J 1959;10(10):1168-73.
    OpenUrl
  3. ↵
    1. Chapeski A
    . Practice tip. Simple cure for the ingrown toenail. Aust Fam Physician 1998;27(4):299.
    OpenUrlPubMed
  4. ↵
    1. Pearson HJ,
    2. Bury RN,
    3. Wapples J,
    4. Watkin DF
    . Ingrowing toenails: is there a nail abnormality? A prospective study. J Bone Joint Surg Br 1987;69(5):840-2.
    OpenUrlPubMed
PreviousNext
Back to top

In this issue

Canadian Family Physician: 54 (11)
Canadian Family Physician
Vol. 54, Issue 11
1 Nov 2008
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Ingrown toenail or overgrown toe skin?
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Ingrown toenail or overgrown toe skin?
Henry Chapeskie
Canadian Family Physician Nov 2008, 54 (11) 1561-1562;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Ingrown toenail or overgrown toe skin?
Henry Chapeskie
Canadian Family Physician Nov 2008, 54 (11) 1561-1562;
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Indications
    • Materials
    • Procedure
    • Discussion
    • Footnotes
    • References
  • Figures & Data
  • CFPlus
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • Toenail resection
  • PubMed
  • Google Scholar

Cited By...

  • Reperfusion injury after Vandenbos procedure in the primary care office
  • Common nail changes and disorders in older people: Diagnosis and management
  • Google Scholar

More in this TOC Section

Practice

  • Managing type 2 diabetes in primary care during COVID-19
  • Effectiveness of dermoscopy in skin cancer diagnosis
  • Spontaneous pneumothorax in children
Show more Practice

Praxis

  • Assessment and management of disability due to mental disorders
  • Éponge à haut rebond comme outil de simulation d’une suture périnéale
  • High-rebound sponge as a simulation tool for perineal suture
Show more Praxis

Similar Articles

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • LinkedIn
  • Instagram
  • RSS Feeds

Copyright © 2025 by The College of Family Physicians of Canada

Powered by HighWire