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Finger nail configuration is influenced by mechanical forces on finger pads

We tried to correct the nail deformity by taping technique, however, onychogryphosis was not improved. Next, we attempted to remove the nail because some cases of onychogryphosis have been healed by extraction of the nail alone. Six months after extraction of the toenail, a healthy and pink nail had regrown (Fig. 1d). Pincer or incurved nails are a deformity characterized by transverse over-curvature of nail. Previously, surgical treatments, such as partial matricectomy or nail bed plasty, have been conventional therapies for pincer nails. These therapies are invasive and sometimes associated with side-effects including nail deformity, procedure-related pain and postoperative pain. Recently, conservative treatments using elastic wires for pincer nails were reported. The attachment of wires to nails does not require local anesthesia and are not accompanied by pain. The local anesthesia for nail surgery is risky for patients who take anticoagulant medicine and causes nerve injury, a rare but serious complication. Some reports proved that these methods were good conservative alternatives to operative procedures for ingrown toenail. Nevertheless, we should be aware of the sideeffects of non-invasive therapies reported here. A huge amount of pressure loads are on the toe during the toe off-phase of gait. Supporting the great toe, the nail has an important role in locomotion even if the nail is over-curved. Over-curvature of the nail is corrected by elastic wires, resulting in reducing the supporting force for the hallux by the nail. The pathogenesis of onychogryphosis includes insufficient pressure of the nail to support the nail bed. The inadequate compression to the nail bed induces protrusion at the distal edge of the hallux; thereby, normal nail growth is disturbed by a protruded nail bed. Therefore, excessive correction of over-curvature of nails causes onychogryphosis. Based on this experience, we seldom treat a pincer nail in patients not complaining of pain; moreover, in our special clinic for nail disorders, we correct nail over-curvature with a thin wire that has a mild corrective force.