10.5826/dpc.1401a49
Introduction: Ingrown nail is a condition caused by the perforation of the periungual soft tissues on nail folds by the sides of nail plaque, causing inflammation and severe pain. Recently, the role of foot anatomical disorders in ingrown nail development has been emphasized.
Objectives: The main objective of this study aimed to determine whether foot deformities played significant roles in ingrown nail development with objective radiological parameters.
Methods: The study included 64 patients diagnosed with clinical ingrown nail and 71 patients as controls without any ingrown nail history. In both groups, we evaluated the bilateral foot radiographs of patients with ingrown nails for hallux valgus angle (HVA), interphalangeal angle (IPA), and intermetatarsal angle (IMA) associated with hallux valgus, and the calcaneal pitch angle (CPA), talohorizontal angle (THA), and talometatarsal angle (TMA) related to pes planus.
Results: No significant difference was found in terms of hallux valgus radiological measurements of HVA, IPA and IMA as well as pes planus radiological measurements of CPA and TMA values, when compared to controls. THA was statistically significantly higher in the control group (P = 0.025). There was a moderate strength positive relationship between ingrown nail stage and measured TMA for pes planus diagnosis (rho = 0.326; P = 0.04), yet there are no significant correlations between ingrown nail stage and other angles.
Conclusions: Therefore, we do not recommend foot anatomy correction in the prevention and treatment of ingrown nails, unless there is an accompanying foot deformity; however, pes planus is a foot deformity that can accompany patients with severely ingrown nails.
text/xml
2160-9381
3578
en
İlker Fatih Sarı
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
X-ray
Evaluation of Foot Deformities in Patients With Ingrown Nails 
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Original Article
2024-01-31
2023-05-30
2024-01-31
2024-02-21
e2024049
Dermatol Pract Concept
Introduction: Ingrown nail is a condition caused by the perforation of the periungual soft tissues on nail folds by the sides of nail plaque, causing inflammation and severe pain. Recently, the role of foot anatomical disorders in ingrown nail development has been emphasized.
Objectives: The main objective of this study aimed to determine whether foot deformities played significant roles in ingrown nail development with objective radiological parameters.
Methods: The study included 64 patients diagnosed with clinical ingrown nail and 71 patients as controls without any ingrown nail history. In both groups, we evaluated the bilateral foot radiographs of patients with ingrown nails for hallux valgus angle (HVA), interphalangeal angle (IPA), and intermetatarsal angle (IMA) associated with hallux valgus, and the calcaneal pitch angle (CPA), talohorizontal angle (THA), and talometatarsal angle (TMA) related to pes planus.
Results: No significant difference was found in terms of hallux valgus radiological measurements of HVA, IPA and IMA as well as pes planus radiological measurements of CPA and TMA values, when compared to controls. THA was statistically significantly higher in the control group (P = 0.025). There was a moderate strength positive relationship between ingrown nail stage and measured TMA for pes planus diagnosis (rho = 0.326; P = 0.04), yet there are no significant correlations between ingrown nail stage and other angles.
Conclusions: Therefore, we do not recommend foot anatomy correction in the prevention and treatment of ingrown nails, unless there is an accompanying foot deformity; however, pes planus is a foot deformity that can accompany patients with severely ingrown nails.
İlker Fatih Sarı
2024/01/31
10.5826/dpc.1401a49
e2024049
Giresun University Faculty of Medicine, The Department of Physical Medicine and Rehabilitation, Giresun, Turkey
2160-9381
X-ray
en
e2024049
Kalen V, Brecher A. Relationship between adolescent bunions and flatfeet. Foot Ankle. 1988;8(6):331-336. DOI: 10.1177/107110078800800609. PMID: 3402852.
Evaluation of Foot Deformities in Patients With Ingrown Nails 
https://dpcj.org/index.php/dpc/article/download/3578/2419
             Evaluation of Foot Deformities in Patients
                        With Ingrown Nails
   Nihal Sarı1, Gülcan Saylam Kurtipek2, Mehmet Ünal3, Mehmet Öztürk4, İlker Fatih Sarı5


1 Bulancak State Hospital, Department of Dermatology, Giresun, Turkey
2 Selcuk University Faculty of Medicine, The Department of Dermatology, Konya, Turkey
3 Associated Professor Mehmet Ünal Clinic, The Department of Dermatology, Konya, Turkey
4 Selcuk University Faculty of Medicine, The Department of Pediatric Radiology, Konya, Turkey
5 Giresun University Faculty of Medicine, The Department of Physical Medicine and Rehabilitation, Giresun, Turkey



Key words: ingrown toenail, onychocryptosis, hallux valgus angles, pes planus angles, x-ray
Citation: Sarı N, Saylam Kurtipek G, Ünal M, Öztürk M, Sarı İF. Evaluation of Foot Deformities in Patients with Ingrown Nails. Dermatol
Pract Concept. 2024;14(1):e2024049. DOI: https://doi.org/10.5826/dpc.1401a49
Accepted: August 8, 2023; Published: January 2024
Copyright: ©2024 Sarı et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Nihal Sarı, Bulancak State Hospital, Department of Dermatology, Giresun, Turkey. İsmet Paşa, Hamdi Uzunalioğlu
Caddesi Bulancak/Giresun. Phone: +90 5379556347 Fax: +90 454 318 30 30 E-mail: nihal02_kyl@hotmail.com




  ABSTRACT             Introduction: Ingrown nail is a condition caused by the perforation of the periungual soft tissues on
                       nail folds by the sides of nail plaque, causing inflammation and severe pain. Recently, the role of foot
                       anatomical disorders in ingrown nail development has been emphasized.
                       Objectives: The main objective of this study aimed to determine whether foot deformities played
                       significant roles in ingrown nail development with objective radiological parameters.
                       Methods: The study included 64 patients diagnosed with clinical ingrown nail and 71 patients as con-
                       trols without any ingrown nail history. In both groups, we evaluated the bilateral foot radiographs of
                       patients with ingrown nails for hallux valgus angle (HVA), interphalangeal angle (IPA), and intermeta-
                       tarsal angle (IMA) associated with hallux valgus, and the calcaneal pitch angle (CPA), talohorizontal
                       angle (THA), and talometatarsal angle (TMA) related to pes planus.
                       Results: No significant difference was found in terms of hallux valgus radiological measurements of
                       HVA, IPA and IMA as well as pes planus radiological measurements of CPA and TMA values, when
                       compared to controls. THA was statistically significantly higher in the control group (P = 0.025).
                       There was a moderate strength positive relationship between ingrown nail stage and measured TMA
                       for pes planus diagnosis (rho = 0.326; P = 0.04), yet there are no significant correlations between in-
                       grown nail stage and other angles.
                       Conclusions: Therefore, we do not recommend foot anatomy correction in the prevention and treat-
                       ment of ingrown nails, unless there is an accompanying foot deformity; however, pes planus is a foot
                       deformity that can accompany patients with severely ingrown nails.


Original Article | Dermatol Pract Concept. 2024;14(1):e2024049                                                                       1
Introduction                                                       who were in the same age range and who admitted to our
                                                                   hospital with diagnosed lower extremity trauma. The X-rays
An ingrown nail is a pathological condition affecting an           in the Radiology Picture Archiving and Communication
individual daily life by causing pain, inflammation, and
­                                                                  System (PACS) of those who did not have diagnosis with
­functional activity limitation [1]. An ingrown nail is ­defined   ingrown nails and foot complaints in the patient's file, and
as the periungual skin perforation by the opposite nail            who did not have a new or old fracture, congenital foot de-
plate [2]. Most commonly, stinging initiates at the distal         formity in imaging were included. The approval for the study
end of one or both lateral nail grooves [3]. Ingrown nails         was obtained from the Non-Invasive Clinical Research Eth-
commonly occur in adolescents and young adults; however,           ics Committee.
their incidence is higher in men [1,4]. Ingrown nails possibly         The study recorded the demographic data, including age,
occur owing to improperly trimmed nails, abnormal shape            sex, occupation, presence of comorbid systemic diseases,
of nails, hypertrophy of the lateral nail folds, congenital or     heights, weights, and body mass index (BMI) of the indi-
acquired nail disorders, nail infections, factors enhancing        viduals in both the patient and control groups. The study
external pressure such as wearing tight shoes, genetic pre-        evaluated the duration of the stinging complaint of those in
disposition, obesity, trauma, subungual tumors, excessive          the patient group, whether there was a previous history of
sweating, and medications [5,6]. Recently, the role of foot        ingrown nails, the foot with the ingrown nail, the ingrown
anatomical disorders in ingrown nail development has been          nail edge, or nail trimming patterns. The classification mod-
emphasized. With the distal phalanx deviation to the lateral       ified by Mozena was used to assess the severity of ingrown
side, the external pressure owing to the lateral nail edge         nails [8].
also increases, possibly playing a role in the development of
­ingrown nails [7]. The commonly occurring deformities are         Radiographic Analysis and the Technique
hallux valgus, defined as the lateral deviation of the big toe,    The aforementioned angles in hallux valgus and pes planus
and pes planus characterized by the collapse of the medial         were measured by a radiologist who was blinded to the group
longitudinal arch. However, only a limited number of previ-        the individuals belonged to, and the data were recorded. Indi-
ous studies have investigated the relationships between these      viduals in both the patient and control groups, the HVA, IPA,
deformities and ingrown nails with conflicting results.            and IMA were measured in the anteroposterior foot radio-
                                                                   graphs (Figure 1). Moreover, the CPA, THA, and TMA were
Objectives                                                         measured on the lateral foot radiographs where the weight
                                                                   was placed on the ground (Figure 2). The angle measurement
The present study evaluated the bilateral foot radiographs of
patients with ingrown nails for hallux valgus angle (HVA),
interphalangeal angle (IPA), and intermetatarsal angle (IMA)
associated with hallux valgus, and the calcaneal pitch angle
(CPA), talohorizontal angle (THA), and talometatarsal an-
gle (TMA) related to pes planus, and the presence of foot
deformities by measuring these angles. Moreover, the study
investigated the relationship between the severity of ingrown
nails and angles measured.


Methods
Patients and Controls
This prospective and controlled study included a total of 64
patients with ingrown nails aged between 18–77 years who
reported to our clinic, between December 2018 and June
2019. A total of 76 feet with ingrown nails were evaluated.
The exclusion criteria were as follows: patients who were
younger than 18 years; those who were pregnant and lactat-
ing; those with subungual exocytosis; those with significant
clinical deformities in the forefoot, midfoot and hindfoot;        Figure 1. The measurement of angles for hallux valgus. (A) Interme-
and those with a history of past osteoarticular surgery and        tatarsal angle (IMA). (B) Hallux valgus angle (HVA). (C) Interpha-
severe traumas. The control group comprised 71 individuals         langeal angle (IPA).



2                                                                       Original Article | Dermatol Pract Concept. 2024;14(1):e2024049
was conducted based on the techniques mentioned in the                was measured for TMA. Values of 15° and below, 30°, and
reference literature. The angle between the longitudinal axis         4° and above were considered pathological in terms of pes
of the proximal phalanx and first metatarsal for HVA, that            planus for CPA, THA, and TMA, respectively [10].
between the longitudinal axis of the proximal and distal pha-
lanx for IPA, and those between the longitudinal axis of the          Statistical Analysis
first and second metatarsal for IMA were also measured. In            The data obtained were transferred to the computer and
hallux valgus, values of 15° for HVA, 10° for IPA, and 9° and         analyzed in the IBM SPSS (version 21.0) package program.
above for IMA were considered pathological [9]. The lateral           The descriptive statistics were presented as mean ±standard
foot radiographs were used to evaluate the radiological an-           deviation and percentages. The Kolmogorow-Smirnov test
gles for pes planus with the individual standing and both             was used to examine the conformity of the variables to the
knees in full extension. The angle between the horizontal             normal distribution. The variables with normal distribution
line passing through the floor and a plantar axis extending           between two independent groups were determined using
between the posterior and anterior tuberosities of the calca-         the independent samples t-test. The statistical significance
neus was measured for CPA; the angle between the mid-talar            between two independent groups for the variables that
line and ground surface where the foot was placed was mea-            did not fit the normal distribution was assessed using the
sured for THA; and the angle between the midtarsal line and           Mann-Whitney U-test. Pearson Chi-Square and Fisher Ex-
line connecting the navicular bone and first metatarsal shaft         act tests were used to evaluate the categorical variables. The
                                                                      stage of the ingrown nail was correlated with the angles that
                                                                      were used to evaluate pes planus and hallux valgus using
                                                                      Spearman correlation test. A P value less than 0.05 was con-
                                                                      sidered statistically significant.



                                                                      Results
                                                                      Table 1 shows the age, sex, BMI, occupation, and comorbid-
                                                                      ity data. The mean age was 32 (18–77) and 34 (18–75) years
                                                                      in the ingrown nail and control groups, respectively. A to-
                                                                      tal of 180 feet were evaluated; 76 were symptomatic feet of
                                                                      64 patients with ingrown nails and 104 feet of 71 individuals

Figure 2. The measurement of angles for pes planus. (A) Calcaneal
                                                                      with a foot radiograph in the control group. No statistically
pitch angle (CPA). (B) Talohorizontal angle (THA). (C) Talometatar-   significant differences were detected between the groups in
sal angle (TMA).                                                      terms of sex, age, and BMI values. The mean duration of


                                  Table 1. Demographic data and comorbid diseases.
                                                                        Patient group               Study group
                                                                           (N = 64)                   (N = 71)          P value
 Age, year±SD                                                            32.41±15.99                34.96±12.94          0.127
 Sex, N (%)
   Female                                                                  27 (42.2)                  35 (49.3)          0.408
   Male                                                                    37 (57.8)                  36 (50.7)
 BMI, kg/cm²±SD                                                           26.18±4.65                 27.80±5.13          0.057
 Occupation, N (%)
  Student                                                                  29 (45.3)                  18 (25.3)
  Desk job                                                                  7 (10.9)                  11 (15.5)          0.083
  Housewife                                                                11 (17.2)                  21 (29.6)
  Job without sitting                                                      17 (26.6)                  21 (29.6)
 DM, N (%)                                                                  6 (9.4)                        5 (7.0)       0.621
 HT, N (%)                                                                  4 (6.2)                    8 (11.3)          0.306
 Additional dermatologic diseases, N (%)                                    5 (7.8)                        1 (1.4)       0.101
 Cardiac diseases, N (%)                                                    1 (1.6)                        4 (5.6)       0.369

BMI = body mass index; DM = diabetes mellitus; HT = hypertension; SD = standard deviation.



Original Article | Dermatol Pract Concept. 2024;14(1):e2024049                                                                    3
ingrown nails was 15 months in the patient group. Ingrown           in 60.05% and 84.2% of patients, respectively. Accord-
nails were higher in women on the lateral side of the thumb         ing to THA and TMA values, pes planus was detected in
than that in men at significant levels in 73.7% of the patients     23.7% and 59.2% of the patients, respectively. THA was
(P = 0.004). Considering the stages, stage 1 ingrown nail was       found to be statistically significantly higher in the control
the most common (Table 2).                                          group (P = 0.025). When it was examined whether there
     Table 3 shows the measured values of HVA, IPA, IMA,            was pes planus according to THA, pes planus was found
CPA, THA, and TMA of the patient and control groups. Ac-            in 23.7% of the patients in the group with ingrown nails.
cording to HVA and IPA values, hallux valgus was detected           However, no significant differences were detected between


                                     Table 2. Clinical features of patient group.
                                                                                  Patient group
                                                                                     (N = 64)
                                                       Female                  Male                    Total
                                                       (N = 27)               (N = 37)                (N = 64)           P value
 Duration, month±SD                                  14.48±25.33            16.92±30.15            15.89±28.03            0.951
 Side, N (%)
  Right                                               10 (37.0)             16 (43.3)               26 (40.6)
                                                                                                                          0.853
  Left                                                12 (44.5)             14 (37.8)               26 (40.6)
  Bilateral                                            5 (18.5)              7 (18.9)               12 (18.8)
 Nail trimming shape, N (%)
  Straight                                             7 (25.9)             15 (40.5)               22 (34.4)             0.224
  İmproper                                            20 (74.1)             22 (59.5)               42 (65.6)
 History of ingrown nail, N (%)
  Recurrent                                           24 (88.9)             29 (78.4)               53 (82.8)             0.331
  First                                                3 (11.1)              8 (21.6)               11 (17.2)
                                                                       İngrown toenails foot assessment
                                                                                  (N = 76)
                                                       Female                  Male
                                                       (N = 32)               (N = 44)                 Total
 İngrowing edge, N (%)
  Lateral                                             29 (90.6)              27 (61.4)              56 (73.7)             0.004
  Medial                                                3 (9.4)              17 (38.6)              20 (26.3)
    Stage, N (%)
    Stage 1                                           18 (56.2)              21 (47.7)              39 (51.3)
    Stage 2a                                            3 (9.4)               9 (20.5)              12 (15.8)             0.628
    Stage 2b                                           4 (12.5)               5 (11.4)               9 (11.8)
    Stage 3                                            7 (21.9)               9 (20.4)              16 (21.1)

SD = standard deviation.


    Table 3. Radiographic parameters of pes planus and hallux valgus in the study and control group.
                                                     Study group                      Control group
                                                      Mean±SD                           Mean±SD
                                                       (N = 76)                         (N = 104)                      P value
                                                                   Pes Planus Evaluation
 Calcaneal pitch angle                                20.22±5.79                         20.00±7.01                     0.823
 Talohorizontal angle                                 26.70±4.87                         28.43±5.17                     0.025
 Talometatarsal angle                                  6.68±4.64                         7.79±5.44                      0.161
                                                                  Hallux Valgus Evaluation
 Hallux valgus angle                                  16.36±7.54                         18.05±6.51                     0.110
 Intermetatarsal angle                                 9.94±2.66                         9.24±2.65                      0.084
 Interphalangeal angle                                15.09±5.45                         15.27±5.44                     0.697

SD = standard deviation.



4                                                                       Original Article | Dermatol Pract Concept. 2024;14(1):e2024049
       Table 4. Spearman correlation between the stage of ingrown nail and the evaluation angles
                              of pes planus and hallux valgus (N = 76).
                                                            Pes Planus                                    Hallux Valgus
                                               CPA               THA            TMA              HVA           IMA            IPA
     Ingrown nail staging                     -0.019             0.179         0.326**           -0.089        0.069         -0.086

CPA = Calcaneal pitch angle; HVA. Hallux valgus angle; IMA = Intermetatarsal angle; IPA = Interphalangeal angle; THA = Talohorizontal
angle; TMA = Talometatarsal angle.
** P <0.01



the hallux valgus-related HVA, IMA, and IFA, and the pes                 development at the lateral nail margin, as suggested by Dar-
planus-related CPA, and TMA measurements of the individ-                 wish et al. HVA and IPA values measured in the ingrown nail
uals in the patient and control groups (Table 4).                        feet were higher at significant levels when compared to the
    A moderately strong and positive relationship was de-                contralateral feet of the patient group and normal controls.
tected between TMA and stage when the relationship be-                   Therefore, based on these results, abnormal HVA and IPA
tween the stage of an ingrown nail and angles in which                   were concluded as possible risk factors in the pathogenesis
pes planus and hallux valgus were evaluated was consid-                  of ingrown nails [7]. In the study conducted by Fernández
ered (rho = 0.326; P = 0.04), and no significant relation-               et al, the presence of pathological IPA was interpreted as one
ship was detected between other aspects and the stage of                 of the possible underlying causes of ingrown nails [15]. In a
ingrown nails.                                                           population-based study conducted by Cho et al, hallux val-
                                                                         gus was found as the most common acquired malalignment
                                                                         in patients with ingrown nails [13]. Abnormal IMA and HVA
Conclusions                                                              angles were reported as important in the etiology of ingrown
Ingrown nail, a painful condition, is a health concern af-               nails by Rota et al [16]. In contrast, Köse et al detected no
fecting daily life and is frequently detected in dermatology             statistically significant differences between the ingrown nails
clinics [11]. Several factors cause ingrown nails. Knowing               and control group in terms of hallux valgus-related angles.
the etiological factors prevents recurrences that may develop            Their study results were supported by the view that not ev-
owing to the treatments applied.                                         ery individual with hallux valgus has ingrown nails [17]. In
    The lateral nail fold of the big toe is the most frequently          the present study, no significant differences were found in
affected area in ingrown nails. It has been suggested that in-           HVA, IFA, and IMA between those with ingrown nails and
grown toenails develop due to the compression of the lateral             the control group.
nail fold between the two fingers, causing inflammation, in-                Pes planus is another common deformity in society,
fection and granulation tissue [12,13]. In our study, 73.7%              which is 8–24-fold more common in adolescents with hallux
of all patients had lateral stinging, which supports these data          valgus [18]. To the best of our knowledge, no study has in-
in the literature. Ingrown nail on the lateral margin was                vestigated the relationship between midfoot deformities and
observed more frequently in both women and men, and it                   ingrown nails. Therefore, this study aimed to evaluate the re-
was found to be statistically significant in women compared              lationship between ingrown nails and the presence of pes pla-
to men (90.6% versus 61.4%). Since women prefer high-                    nus. In the population-based study conducted by Cho et al.
heeled pointed-toed shoes more, the pressure on the big toe              pes planus was found to be a risk factor in the development
increases, and the pressure applied towards the lateral edge             of ingrown nails, based on the International Classification of
of the nail increases due to the narrowing of the toe box                Disease codes. They also elucidated the relationship between
located at the tip of the pointed shoe [14]. We attribute the            pes planus and ingrown nails by the weight-bearing feature
statistically more significant stinging on the lateral margin in         of the medial side of the big toe owing to the collapsed arch
women to this.                                                           of the foot with increasing pressure [13]. In our study, we
    The role of foot anatomical disorders in the development             found that THA was statistically significantly higher in the
of ingrown nails has been emphasized in recent years. The                control group (P = 0.025). According to THA, pes planus
present study also aimed to determine whether foot defor-                was found in 23.7% of the patients in the ingrown toenail
mities played significant roles in ingrown nail development              group and 36.5% in the control group, and this difference
with objective radiological parameters. Some researchers                 was not statistically significant (P = 0.066). However, no sta-
reported that the presence of hallux valgus plays a role in              tistically significant differences were detected in the present
ingrown nail development. The lateral deviation of the distal            study between the ingrown nails and the control group in
phalanx increases the internal pressure, causing ingrown nail            terms of CPA, and TMA.



Original Article | Dermatol Pract Concept. 2024;14(1):e2024049                                                                        5
    Studies evaluating the correlation of ingrown nail staging                Concept. 2018;8(1):22-27. DOI: 10.5826/dpc.0801a05. PMID:
with angles for hallux valgus and pes planus are still very                   29445570. PMCID: PMC5808367.
                                                                         5.   Zuber TJ. Ingrown toenail removal. Am Fam Physician.
limited. The TMA was measured to detect the presence of
                                                                              2002;15;65(12):2547-2552, 2554. PMID: 12086244.
pes planus, and the ingrown nail stage was detected to have
                                                                         6.   Thommasen HV, Johnston CS, Thommasen A. The occasional
a moderately strong and positive relationship.                                removal of an ingrowing toenail. Can J Rural Med. 2005;10(3):
    Hallux valgus was detected in 60.05% and 84.2% of pa-                     173-180. PMID: 16079034.
tients with ingrown nails, respectively, according to HVA and            7.   Darwish FM, Haddad W, Ammari F, Aoudat Z. Association
IFA. While, pes planus was detected in 23.7% and 59.2% of                     of abnormal foot angles and onychocryptosis. Foot (Edinb).
                                                                              2008;18(4):198-201. DOI: 10.1016/j.foot.2008.05.004. PMID:
patients, respectively, according to THA and TMA. Although
                                                                              20307437.
individuals had pathological hallux valgus and pes planus in
                                                                         8.   Mozena JD. The Mozena Classification System and treatment
the patient group according to the reference values, no signifi-              algorithm for ingrown hallux nails. J Am Podiatr Med Assoc.
cant differences were detected compared to the control group.                 2002;92(3):131-135.      DOI:      10.7547/87507315-92-3-131.
It was linked with the frequent occurrence of foot deformities.               PMID: 11904324.
One of the study limitations was that radiographic angle mea-            9.   Kılıçoğlu O. Ayak başparmağının hastalıkları: Halluks valgus
                                                                              ve halluks rigidus. TOTBİD Dergisi. 2013;12:390–406 .DOI:
surements were not performed on the contralateral foot of the
                                                                              10.14292/totbid.dergisi.2013.48.
patient group. In addition, the control group was randomly
                                                                        10.   Deniz G, Kavaklı A, Ögetürk M, Öztürk D, Tatar N, P ­ erilioğlu AZ.
selected from the PACS data archive. In particular, patients                  Radiographic Evaluation of Flexible Pes Planus in Children on
may apply to the orthopedic outpatient clinic with the com-                   Weight-Bearing and Nonweight-Bearing. F.U. Med.J.Health.Sci.
plaint of chronic foot pain, and hallux valgus and pes planus                 2014;28(3):129–132.
can be detected in these patients. To rule this out, although           11.   Arica IE, Bostanci S, Kocyigit P, Arica DA. Clinical and Sociode-
                                                                              mographic Characteristics of Patients with Ingrown Nails. J Am
we included the foot x-rays (without new or old fracture and
                                                                              Podiatr Med Assoc. 2019;109(3):201-206. DOI: 10.7547/17-023.
malformation) of patients with lower extremity trauma in
                                                                              PMID: 31268783.
the control group, some of the x-rays in the control group              12.   Pearson HJ, Bury RN, Wapples J, Watkin DF. Ingrowing toenails: is
were belonged to Orthopedics outpatient clinic. Although we                   there a nail abnormality? A prospective study. J Bone Joint Surg Br.
tried to minimize this limitation, hallux valgus and pes planus               1987;69(5):840-842. DOI: 10.1302/0301-620X.69B5.3680356.
deformities may have been found to be high in the control                     PMID: 3680356.
                                                                        13.   Cho SY, Kim YC, Choi JW. Epidemiology and bone-related comor-
group, due to x-rays of the orthopedic outpatient clinic.
                                                                              bidities of ingrown nail: A nationwide population-based study.
    An increased risk for the presence of pes planus and
                                                                              J Dermatol. 2018;45(12):1418-1424. DOI: 10.1111/1346-8138
hallux valgus deformities was not detected in patients with                   .14659. PMID: 30264897.
ingrown nails when compared to the normal population.                   14.   Menz HB, Roddy E, Marshall M, et al. Epidemiology of Shoe
Therefore, we do not recommend foot anatomy correction in                     Wearing Patterns Over Time in Older Women: Associations With
the prevention and treatment of ingrown nails, unless there                   Foot Pain and Hallux Valgus. J Gerontol A Biol Sci Med Sci.
                                                                              2016;71(12):1682-1687. DOI: 10.1093/gerona/glw004. PMID:
is an accompanying foot deformity; however, pes planus is
                                                                              26834078. PMCID: PMC5106851.
a foot deformity that can accompany patients with severely
                                                                        15.   Córdoba-Fernández A, Montaño-Jiménez P, Coheña-Jiménez
ingrown nails.                                                                M. Relationship between the presence of abnormal hallux
                                                                              interphalangeal angle and risk of ingrown hallux nail: a case
References                                                                    control study. BMC Musculoskelet Disord. 2015;16:301. DOI:
                                                                              10.1186/s12891-015-0749-1. PMID: 26472543. PMCID:
 1. Martínez-Nova A, Sánchez-Rodríguez R, Alonso-Peña D. A new                PMC4608311.
    onychocryptosis classification and treatment plan. J Am Podi-       16.   Dincer Rota D, Bozduman Ö, Tanacan FE, et al. Abnormal
    atr Med Assoc. 2007;97(5):389-393. DOI: 10.7547/0970389.                  foot angles has an association with ingrown toenail. Int J Clin
    PMID: 17901344.                                                           Pract. 2021;75(10):e14474. DOI: 10.1111/ijcp.14474. PMID:
 2. DeLauro NM, DeLauro TM. Onychocryptosis. Clin Podiatr Med                 34107146.
    Surg. 2004;21(4):617-630. DOI: 10.1016/j.cpm.2004.05.009.           17.   Kose O, Celiktas M, Kisin B, Ozyurek S, Yigit S. Is there a re-
    PMID: 15450901.                                                           lationship between forefoot alignment and ingrown toenail?
 3. Haneke E. Controversies in the treatment of ingrown nails. Derma-         A case-control study. Foot Ankle Spec. 2011;4(1):14-17. DOI:
    tol Res Pract. 2012;2012:783924. DOI: 10.1155/2012/783924.                10.1177/1938640010382293. PMID: 20921151.
    PMID: 22675345. PMCID: PMC3362847.                                  18.   Kalen V, Brecher A. Relationship between adolescent bunions
 4. Tian J, Li J, Wang F, Chen Z. A new perspective on the nail               and flatfeet. Foot Ankle. 1988;8(6):331-336. DOI: 10.1177
    plate for treatment of ingrown toenail. Dermatol Pract                    /107110078800800609. PMID: 3402852.




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