The Stainless Steel Wire-based Method of Sogawa Effectively Corrects Severe Ingrown Nails

Summary:

Ingrown nails are defined as inflammation of the lateral nail fold that is caused by penetration by the nail plate and associates with pain and/or infection. The pain associated with ingrown nail hampers walking, raises the risk of falls, and decreases the quality of life. The Sogawa method is a novel conservative medical treatment for ingrown nails that is based on stainless steel wire. It was first reported in 2012 by Sogawa, and we have found that it is very effective for ingrown nails, especially in difficult cases. Here, we show the beneficial effects of the Sogawa method in 2 extremely difficult cases where ingrown nails had recurred after partial nail ablation. We found the Sogawa method to be a quick and easy technique that rapidly improves the pain associated with ingrown nails and later produces properly configured nails. Our experience suggests that it is suitable for severe ingrown nails, such as too short ingrown nails and ingrown nails that have strong inflammation and granulation tissue formation. This is significant because it is difficult to treat such cases with conventional conservative methods, which means that the only remaining therapeutic option is surgery. Thus, the Sogawa method is a novel and highly effective ingrown nail treatment that obviates the need for invasive surgical treatment.

Ingrown nails are defined as inflammation of the lateral nail fold that is caused by penetration by the nail plate and associates with pain and/or infection.¹ The Sogawa method is a novel conservative medical treatment for ingrown nails that is based on stainless steel wire. It was first reported in 2012 by Sogawa.² Since then, this method has not been further discussed in the literature. However, we found that this method treats ingrown nails very effectively, including difficult cases that would normally have to be treated by invasive surgical treatment. Here, we introduce the beneficial effects of the Sogawa method for extremely difficult ingrown nail cases.

THE SOGAWA METHOD

The Sogawa method² is based on stainless steel wires. One end of the wire is shaped with a bending device into a hook that has to be fitted under the ingrown edge of the nail. The hook is then introduced under the nail in the nail crease or under the nail tip at or near the most painful point (Fig. 1). Thereafter, the wire is laid on the surface of the nail in the direction of the opposing lateral nail fold. Then, the wire pulls the ingrown edge of the nail up out of the nail crease (Fig. 1). Thus, after placing the hook, the fixation point near the opposing nail crease is determined. The wire is cut into the appropriate size and fixed by using a bond enhancer (Ortho Solo Universal Bond Enhancer Dental Adhesive Bonding Orthodontic Ormco.co., Orange, Calif.) and photopolymerizing resin (Filtek Supreme Ultra Universal Restorative 3M, Monrovia, Calif.) with ultraviolet (wavelength, 420–480 nm) irradiation (Fig. 1). One to 2 months later, the wire falls off naturally or can be removed by breaking the cured resin with a nipper. New wires can then be applied if required.

Fig. 1.

Schematic diagram of the Sogawa method. The hook is introduced under the nail in the nail crease (). Thereafter, the wire is laid on the surface of the nail in the direction of the opposing lateral nail fold. Then, the wire pulls the ingrown edge of the nail up (). The wire is fixed to the surface of the nail ().

CASE REPORTS

Case 1

A 48-year-old man was frequently bothered by the pain arising from the ingrown nail of his left great toe for more than 30 years. He had undergone temporary partial nail avulsion without chemical or surgical ablation many times. However, the ingrown nail relapsed each time and the pain gradually worsened. As a result, 2 years ago, the patient underwent phenol matricectomy in another clinic. However, the ingrown nail recurred again (Fig. 2). We treated him with the Sogawa method and 4 days of oral antibiotics. Pain reduction was observed immediately after application of the wire (Fig. 2). In total, the nail was treated with 4 wires over 6 months. The nail configuration improved gradually but significantly (Fig. 2). Since then, the patient has undergone preventive wire therapy every 6 to 12 months when there is some indication of nail recurvature. He is free of pain and has a satisfactory nail configuration.

Fig. 2.

Clinical appearance and therapeutic course of case 1. A, Appearance before treatment. The patient had undergone partial matricectomy, but the regrowth of the nail plate led to severe pain. B, Appearance after wire application. C, Six months later, the nail configuration had become almost flat.

Case 2

For more than 7 years, a 19-year-old woman was occasionally bothered by pain arising from the ingrown nail of her right great toe. She underwent partial matricectomy 2 years ago in another clinic, but eventually, the remaining nail started to curve and cause pain again. She then cut the lateral nail too short in an effort to reduce the pain, but it only worsened her pain. We applied the Sogawa method. The patient reported that the pain ceased immediately after the wire had been attached. Two days later, the edge of the nail plate had been elevated out of the nail crease and the swelling of the lateral nail fold had decreased. Forty days after her first visit, the inflammation and nail configuration had improved dramatically. The patient has been free from relapse of ingrown nail for 1 year after treatment.

DISCUSSION

Many conservative^3,4 and surgical methods^5,6 for treating ingrown nails have been reported. Although surgical treatment can achieve a rapid return to normal activities, it is invasive and can lead to cosmetic problems, including a narrow nail shape and operated–nonoperated asymmetry. Moreover, recurvature of the remaining nail may continue and lead to severe pain.^1,6 Furthermore, in patients with an unfavorable general condition, severe ingrown nail and invasive treatment can trigger ulcers, gangrene, sepsis, and life-threatening infections.^6,7 Thus, conservative treatment may be preferable for such patients. However, it is very difficult to treat severe ingrown nails with conventional conservative methods. As a result, these cases often ultimately require surgical treatment.¹

We describe here 2 cases of severe ingrown nails. Normally, we would have had to treat these cases surgically. However, we found that the Sogawa method dramatically improved the configuration of the nail over time. Most notably, the pain of both patients ceased immediately after the treatment. Thus, our results suggest that this method, which is quick and easy, can rapidly eliminate the pain and gradually improve the configuration of severe ingrown nails that would normally have to be treated surgically. Similarly, Sogawa⁸ reported in his oral presentation at a Japanese orthopedic meeting in 2014 that he has been able to improve 510 pincer and ingrown nails by using this method without having to resort to surgical treatment. Thus, the Sogawa method is an important advance in the treatment of ingrown nail because it is easy and highly effective in correcting nail configuration, relieves pain immediately, and obviates the need for invasive surgical treatment.

It should be noted, however, that the Sogawa method may not be suitable for cases with huge granulation tissues with inflammation. In such cases, the Sogawa method should be used after removal of the granulation tissues by applying an external preparation or surgical treatment. For cases of extremely thin or softened nails, careful selection of the wire size is required to avoid nail splitting or peeling. Furthermore, it is preferable to avoid strenuous activity or strong external forces during treatment to prevent the wire from dropping off. Moreover, further investigations, such as those, directed at determining complications and recurrence rates are needed.