The purpose of this paper is to propose a rational treatment protocol according to basic surgical principles, anatomy of the nail bed, and etiological factors. Ingrown toenails have been discussed in medical literature for more than 1300 years. The condition commonly affects young adults and may result in significant morbidity in terms of loss of days from work, education, and recreation. The anatomy and physiology of the nail bed are presented to promote better selection of the proper management procedure. Ingrown toenails can be classified in terms of congenital or acquired causes. A surgical protocol, along with a description of each surgical technique, is supplied. The pathology of onychogryphosis is classified in terms of involvement of the germinal matrix, the sterile matrix, or both. Treatment is determined by the severity and underlying medical condition of the patient.
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