By Keith Loria
Onychocryptosis, more commonly known as in-grown toenail, affects nearly 20% of all patients who present a foot problem to their doctor. Current treatments include incisional procedures and nonincisional procedures, such as chemical matrixectomies and physical matrixectomies using a carbon dioxide laser. Treatment innovations have been slow, with some current standards of care dating back to the 1940s, which is why there’s rising interest in a new way to treat this recurrent problem.
In the past, the 1064-nm laser was used as a treatment for plantar warts and nail matrixectomies, so it seemed logical that it could be used for onychocryptosis.
Lluís Castillo Sánchez, master in surgical podiatry and professor of chiropodology and podiatric surgery at UManressa, led a study by Barcelona University to determine if the 1064-nm laser technique would be a good fit for onychocryptosis.
“The genesis of this study is that the laser 1064-nm was being used for a long time for the treatment of fungic infections of the nails, so we thought that also this laser could be effective for the matrixectomy in the nail surgery,” Sánchez told LER by email. “Our goals were to describe this new procedure and its effectiveness, comparing also with one of the most used procedures in nail surgery like the fenol-alcohol technique.”
In the publication, “Onychoplasty with 1064-nm Laser: Matrixectomy for Treatment of Ingrown Toenails,” which was recently published in the Journal of the American Podiatric Medical Association, the authors provide details for the surgical onychoplasty using a physical matrixectomy with a 1064-nm laser applied by means of a 400-μm optical fiber and surgical removal of the posterior cauterized tissue to achieve healing by primary intention.
Sánchez explained the parameters studied were post-surgical pain (using the Visual Analog Scale [VAS]), infection, and inflammation and recurrence at 6 and 12 months post-procedure. The patients, who were from multiple centers, were randomized.
“We had 30 patients in the study (60% male and 40% female, with an average age of 32.4 years), and four variables were followed,” Sánchez said. “Looking at postoperative pain, 97% of patients reported having mild pain (VAS, 2-3), 3% reported having moderate pain (VAS, 5-6), and there was no case of severe pain.”
The second variable, postoperative infection, was reported in 5.3% of patients. Postoperative cicatrization time averaged 10 to 12 days for all patients.
“Our fourth variable was postoperative recurrence, and we saw no case of recurrence during the 12-month follow-up, although we will consider enlarging the sample in future studies,” Sánchez said.
He noted that the findings showed the 1064-nm laser technique decreases postoperative pain compared with previous methods and also provides a shorter postoperative period for patients, leading to a quicker return to daily routines when compared with incisional procedures, chemical matrixectomies, and carbon dioxide laser treatments.
“Our major takeaway is that this new procedure is very effective with a less post-surgical time than other techniques, with less pain and less recurrence,” Sánchez said. “So, this is a new application of this 1064-nm laser, and the clinicians can apply easily if they have this 1064-nm laser available to them.”
With the study showing positive results, the researchers are next planning to compare this technique with other procedures in more case series.
Keith Loria is a Washington, DC-based freelance writer.
Source: Sánchez LC, Zalacaín-Vicuña AJ. Onychoplasty with 1064-nm Laser: Matrixectomy for Treatment of Ingrown Toenails. J Am Podiatr Med Assoc. 2019;109(5):401-406.