Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
The term “radical cure” does not necessarily indicate the performance
of the so-called radical operation, but may result from proper
treatment of a down-curved nail edge, or of a diseased nail fold,
together with such prophylaxis in foot-gear as is indicated. With
sufficient room in the shoe and the removal of offending granulations
or cutting nail edge, a radical cure can frequently be effected.
Any inflammatory condition, either of the nail or its matrix, or the
tissues contiguous to the nail, may result in the train of symptoms
which are indicative of ingrown nail. When, however, any of these
conditions has existed sufficiently long to cause ingrown nail to be
present, it ceases to be of the first importance; it then becomes
necessary to treat the buried nail edge, or the overgrown soft tissues
themselves.
+The Choice of Method+ between radical and palliative operations will
depend entirely upon the degree of infection present, and the facility
with which it can be reached. Thus, in the event of the entire toe
being red and swollen and much purulent discharge being present, there
will in all probability also exist much inflammatory tissue and a deep
burying of the nail edge.
With a tolerant patient it might be possible to scrape away with a
sharp spoon the granulation tissue, and remove the offending nail
edge; the gradual improvement sought in ordinary cases cannot be
thought of in these cases. It is urgent to relieve the pain and
throbbing and to circumvent the dangers of a spreading infection. The
sensations of a cutting nail edge have been lost in the more severe
development. Should the patient be tolerant of pain, exposure,
disinfection and drainage of the infected area is possible, but in
most instances the contrary will obtain, and the radical operation
with local anesthesia will be indicated.
The possibility of doing an efficient operation will ordinarily
determine the method to be employed.
On the other hand there are a large number of cases in which
palliative treatment is not only effective but emphatically the method
of choice. One might see a degree of burying of nail edge quite as
extensive as in the foregoing, with however, only a slight degree of
infection. The nail fold may be much hypertrophied and granulation
tissue may be abundant. The tenderness and inflammatory condition,
however, is not so great as to interfere with the ordinary procedure.
There is no danger of a rapidly ascending infection, the nail groove
showing no inordinate amount of discharge. It is in these cases that a
permanent cure frequently results from the mere removal of the
irritating nail edge followed by the disinfection of the nail groove.
It is held by many that all cases of ingrown nail, except those due to
a true hypertrophy of the nail, would remain permanently cured were it
not for short or badly shaped shoes.
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