Presenting complaint

A 25 year old white Caucasian female attended my clinic complaining of left dorsal hallux pain. She had been to the local night club in Stevenage a few nights earlier and a rather large man accidentally stood on her left foot whilst dancing. She was unable to continue with the dancing and was taken home by taxi.

She did attend the local hospital on an outpatient basis and it was thought that an x-ray would not be required.

Medical History

The patient is in good general health with no noted medication except the use of NSAID’s for the hallux pain. The VAS pain was noted as a ‘7’, throughout the day.

Assessment

On palpation acute tenderness was noted along the margins of the dorsal phalanges, with some soft tissue swelling and bruising along the joint. Mild hyper-granulation tissue around the medial nail margin was also noted. The nail was clearly in-grown on inspection.

The patient had a reasonably good range of dorsiflexion and plantarflexion of the hallux.

 

Management of an ingrown toe nail using Acupuncture
Management of an ingrown toe nail using Acupuncture

Diagnosis

Mild medial left 1 onychocryptosis was diagnosed with acute soft tissue swelling along the dorsal phalanges.

Treatment

The method of treatment was to be conservative removal of the offending nail piece by wedge resection. Dry acupuncture needling was suggested to the patient for pain relief and to reduce the soft tissue swelling.

Treatment method

Rx 1

Acupuncture for 30 minutes LI4 Li1 Li2 Ki1 SP1 SP2 and 4 needles inserted around the outside of the bruising. The needles were stimulated manually every 5 minutes.

The offending nail piece was removed by conservative wedge resection and the toe was dressed with a sterile pad and tubigauze.

The patient reported feeling no pain during the podiatry treatment with no adverse reactions.

She was instructed to soak the foot in salt water daily, after the removal of the dressing and to elevate the foot as much as possible. Additionally she was advised to use an ice pack on the soft tissue swelling for 5 minutes daily.

Review 1 Week

During the week I received a phone call from the patient to cancel the appointment. She stated that the toe was much better and the soft tissue swelling had greatly reduced. The VAS was noted as a ‘3’.

Discussion

The acupuncture needling enabled painless removal of the offending nail and helped to greatly reduce the soft tissue swelling.

Local and distal points chosen for their therapeutic effects

LI4 – Important analgesic point

Li1 – Arrests bleeding

Li2 – Pain and swelling

Ki1 – Pain and swelling

SP1 – Arrests bleeding

SP2 – Pain and swelling

Surround the dragon – Pain and swelling

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