RU2847198C1 - Method for correcting deformity of the nail plate and ingrown toenail - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to dermatology and podology, and can be used to correct deformity of the nail plate and ingrown toenail. The staple is made from orthodontic ligature with elasticity, which can be deformed by a tool, but at the same time retains elasticity, then the m-shaped base of the staple is formed with two-sided or one-sided orthodontic pliers, while the bends of the extreme parts of the base are shaped in the form of a semi-omega. In this case, the base is made to fit the width of the adjusted nail plate in compliance with the specified shape of the bracket. The brace is activated by compressing it, after which the resulting brace is fixed on the patient's nail.

EFFECT: to provide physiological correction of the deformation of ingrown and deformed nail plates due to the increased size of the spring part of the loop and the gradual change in the shape of the nail plate.

6 cl, 28 dwg, 5 ex

Description

Field of technology

The invention relates to medicine, namely podiatry, and is used to correct ingrown and deformed nails.

State of the art

Nail correction systems (braces) have been used worldwide for 200 years. They help correct curled nails through controlled physical tension, change the direction of nail growth, restore nail shape after surgery, and prevent ingrown nails, allowing nails to grow out open and flat. Nail correction systems work similarly to dental braces and differ in shape, active physical forces, manufacturing methods, and application options.

The most popular staples in use are the Fraser staple, 3TO, Ora, Titanium thread, Podofix.

On the other hand, corrective systems are a painless and conservative way to get rid of deformation and ingrown nails, which, compared to surgical methods, is the safest way to solve the problem.

A kit for performing a method for correcting toenails or fingernails in humans or animals is known from the prior art. The nail correction kit allows for the simple correction of the shape of ingrown fingernails or toenails. Depending on the degree of nail deformation, primarily the degree of curvature, compositions based on photopolymerizable components can be used. The nail correction kit proposed in the invention comprises: a primer containing hydroxyethylene methacrylate in an amount of 40 to 59.9%, phosphate dimethacrylate in an amount of 40 to 60%, an initiator in an amount of 0.1 to 1.0%; at least one composition for forming a photocurable corrective staple, containing bisphenol A (di)methacrylate and urethane dimethacrylate in a ratio of 1:5 to 5:1 in an amount of 15 to 45%, fillers and pigments in an amount of 84.9 to 55%, Page: 1 R U 2764999 C 2 R U 2764999 C 2 camphorquinone, an amine initiator in an amount of 0.1 to 1%; and, if necessary, one or more metal elastic staples (RU 2764999 C2 24.01.2022).

In addition, a method for correcting a nail is known, characterized in that a piece of wire made of an elastic material is placed in a recess of a nail block, the wire is fixed along the edges of the nail block to form at least two loops, a liquid polymer is applied to the places of the formed loops, which forms fastening elements upon hardening, the fastening elements are adjusted until a smooth surface is achieved, the piece of wire is removed from the nail block, the outer ends of the wire are cut off, the fastening elements are further adjusted, the wire with the fastening elements is placed on the nail, the fastening elements are fixed to the sides of the nail with an adhesive joint, after which a loop is formed from the free section of wire protruding above the nail, it is tightened and twisted, the eye of the loop is cut off, a drop of liquid polymer is applied to the cut site and kept until hardening (RU 2803687 C1 19.09.2023).

The closest method to the stated correction method is the NASPAN brace (https://naspan.de) for correcting deformed and ingrown nails. This brace uses an active spring force that acts on the nail plate, virtually eliminating the force of levers. The NASPAN brace is available only as a prefabricated "semi-finished product"—a preformed M-shaped spring of various sizes. The NASPAN brace is made of straight wire elements bent into three loops in the shape of the letter M.

However, a drawback of this brace is the spring's shape, which consists of straight elements. Their force is just as strong at the edges of the nail as it is in the center. Therefore, when using a Nishpan brace, there is a risk of tearing off the vulnerable edges of the nail.

Another well-known method is the Unibrace, which allows for the production of Naspan-type braces using an automatic machine. However, due to the loose fit of the interlocking parts, the resulting shape is curved and open at the center, while the edges of the base are straighter. This means the brace isn't assembled at the center, and the active work is done by the edges of the system, resulting in the resulting shape leading to tearing of the nail plates at the sides. Another significant drawback is the need for expensive equipment to form the ligatures of this brand.

Therefore, corrective systems consist of a single wire or two pieces of wire attached together and operate on the principle of pull levers. When attached to the nail, the flat wire pulls the curled nail into a flat shape.

Braces can employ three elements of physical force: leverage, rotation, and spring. The lever force is provided by the arms of the brace, the rotational force of the nail edges is provided by the hooks, and the spring force is provided by the loops of the brace, which are positioned on the plates.

Some braces have small spring elements that cushion the force and allow for the wire to stretch as the nail flattens. This spring makes the process of nail shaping relatively safe.

Thus, the disadvantages of previously known methods are:

- a small spring loop helps lift the edge of the nail by gradually lifting it, and only after this does the nail straighten out, which means that the work of such braces is not physiological, because the shape of the nail plate is determined not by the nail itself, but by the nail bed - the area of the skin that is located under the nail plate, has the shape of longitudinal ridges and is represented by a longitudinal pattern on the nail plate.

In this case, the process of tight adhesion of the nail to the nail bed is disrupted and a phenomenon called onycholysis occurs - the separation of the nail from the nail bed.

When the nail is no longer attached to the nail bed, it loses its most important function—supporting the nail plate—and shrinks. This phenomenon is called a "slipped nail bed." In other words, the nail bed is replaced by the smooth skin of the anterior and lateral nail folds, which becomes enlarged and rises above the nail plate.

Such a ridge becomes an obstacle to the reverse growth and fusion of the nail plate and leads to such consequences as: ingrowth of the nail into the hypertrophied ridge, disruption of the growth and development of the plate - the nail thickens and takes the shape of a claw (onychogryphic deformity), an increased risk of the appearance of an osteochondral formation on the anterior phalanx of the finger - subungual exostosis or osteochondroma due to the absence of the body of the nail, which protects this ridge, an increased risk of bacterial and fungal infections.

Another problem with the traumatic nature of corrective systems that rely on leverage is that the nail bed is primarily made up of the dermal layer of skin, which is covered by a thin epidermal film and contains a large number of vessels and nerve endings that supply the nail plate with blood. Mechanically tearing the nail damages not only the epidermal film of the nail bed ridges, but also the entire dermal layer of the skin. Unfortunately, any damage to the dermal layer of the skin leads to the formation of microscars on the nail bed, which also impedes nail plate fusion, the development and growth of the nail bed itself, and the subsequent restoration of the nail apparatus.

The problem that the claimed invention is aimed at solving is to eliminate the shortcomings of the above methods, to make the work of the edges of the spring less active, but at the same time to concentrate the maximum movement in the center of the nail - its strongest part, which will ensure physiological correction of the deformation of ingrown and deformed nails.

Disclosure of invention

Explanation of the terminology used in the application materials: it should be noted that the "lever force" and "lever" in the text are understood as "spring pull force", but the element itself to which the force is applied acts as a lever for the nail (the arms of the bracket), which is why the arms of the bracket are designated as a lever.

The technical result of the claimed method allows for physiological correction of ingrown and deformed nails, avoiding the tearing of nail edges, and preventing the formation of onycholysis, osteochondroma, or subungual exostosis.

The specified technical result is achieved through the following methods of correcting a deformed or ingrown nail.

The bracket is made from a medium-elastic metal orthodontic ligature, which can be deformed with an instrument while maintaining its elasticity. Using double-ended or single-ended orthodontic round-nose pliers, the ligature is shaped into an M-shape at the base of the bracket, with the curves of the outer parts of the base forming a semi-omega. This curvature of the ligature ensures a more secure and stable grip on the nail edges.

The base is tailored to the width of the nail plate being corrected, maintaining the specified bracket shape. The bracket is activated by compressing it 4-5 mm, after which the resulting bracket is secured to the patient's nail.

In this case, the brace can be fixed on the patient’s nail with one hook, two hooks, or with glue.

When securing a staple with two hooks, the first hook is inserted under the nail plate and the arm is curved to match the shape of the lateral edge of the nail, so that the ligature follows the nail's curve. Similar manipulations are performed with the second hook, activating the lever and spring forces of the staple, compressing the spring by 4-5 mm and raising the levers by 4-5 mm. Then, clamp the hook with tweezers or a clamp and insert the first hook under the free edge of the nail, where it does not adhere to the nail bed, stretch the ligature, and insert the second hook. Insert the hook along path 1 as shown in Fig. 2 along the nail fold. Upon reaching the nail ingrown point, the staple is unfolded along path 2 as shown in Fig. 22 and placed on the nail. The staple is then secured with dental composite at the points of constant curvature.

When fixing the staple with the adhesive method, without stretching the staple base formed during manufacture, step back 1-2 mm from the edges of the base and bend the ligature upward with a tool to create tails, by which the staple will be pressed against the nail and stretched along it at the moment of fixation. The center of the staple is fixed with composite at the zero point of deformation - point 1 as in Fig. 23, then one part of the staple is stretched by the tail to the extreme point of the nail plate and pressed, after which it is fixed with composite at the point of contact - point 2 as in Fig. 23 with the nail, similarly fix the staple on the opposite side of the nail and at the point of contact with the second part of the staple - point 3, as in Fig. 23. Additionally, fix the remaining bends of the staple base at points 4 and 5. Bit off the excess ligature and completely cover the edges of the ligature with composite.

The adhesive mounting can be designed as a loop, which provides a large contact area with the nail and secures the system.

In addition, the bracket can be fixed on one side with glue and on the other with a hook.

Brief description of the drawings

Fig. 1 shows the force of action of the correction systems, where A is the traction force, B is the spring force, C is the rotation force.

Fig. 2 shows the operation of a small shock-absorbing spring.

Fig. 3 shows the operation of the bracket levers.

Fig. 4 shows the structure of the nail bed, where 1 is the proximal fold, 2 is the body of the nail, 3 is the nail bed, 4 is the root of the nail, 5 is the distal fold.

Fig. 5 shows a nail, where 6 are the longitudinal ridges of the nail plate, which determine the structure and ribbing of the nail.

In Fig. 6, where 7 is the slipped or contracted nail bed, 8 is the smooth distal fold that has replaced the nail bed.

In Fig. 7, where 9 is osteochondroma or subungual exostosis.

Fig. 8 shows a bracket used and formed during the method of correcting the deformation of ingrown and deformed nail plates, which has an M-shape, with bends of the extreme parts of the base in the form of a half-omega.

Fig. 9 shows the operation of a bracket having an M-shape, with bends of the extreme parts of the base in the form of a half-omega.

Fig. 10 shows a step in the method where the target area—a square or rectangle—is visually determined, and the size of the staple base within that area is determined based on its dimensions. The staple is made with a 4-5 mm margin from the side ridges and free edge and at least 2-3 mm from the nail growth zone.

Fig. 11 shows a step in the method of forming the first loop by bending the ligature in the center of the segment I - double-ended round-nose pliers, II - single-ended round-nose pliers

Fig. 12 shows a step in the method of applying a staple to the nail plate in order to visually measure the bending points in two loops, and visually mark these points along the edge of the selected work area, while they should be at the same height.

Fig. 13 shows the next step of the method: under visual control, marking the points at which the ligature is bent into loops. For convenience and to create symmetry, the ligature is inserted horizontally into the flat parts of the instrument and clamped tightly. Using a finger, bend the ligature in different directions to create a symmetrical height for the future bends.

Fig. 14 shows a step in the method: the larger-diameter part of the tool is inserted into the staple's deformation points, and two loops are formed along it. The remaining ends of the ligature are brought parallel to the staple's base axis.

Fig. 15 shows a step in the method where two more points are selected in the middle of the future staple base, which will serve as the transition from the base to the arms. The ligature is bent 180 degrees at these points using the thin base of a pair of round-nose pliers, and then the arms of the staple are lowered 90 degrees using either your fingers or a tool.

Fig. 16 shows a step in the hook manufacturing process, during which the base of the bracket is stretched and deactivated by 4-5 mm and the points where the plate ends are determined, where the bracket will bend into hooks.

Fig. 17 shows a step in the method for continuing to make hooks, in which the ligature is bent 180 degrees at the designated point so that it fits neatly under the shoulder of the staple.

Fig. 18 shows a step in the process where the hook is applied to the end of the nail and the resulting hook is adjusted to the nail's thickness. If the hook is too wide, narrow it by clamping it between the flat ends of round-nose pliers. Cut off the excess ligature, leaving 2-3 mm of ligature that will be secured under the nail plate.

Fig. 19 shows the stage of forming the hook and the action with the staple from the opposite side.

Fig. 20 shows the stage of activating the lever force, if necessary, by 4 mm or to a height of two hooks.

Fig. 21 shows the stage of installing the hooks - we activate the spring of the bracket and compress it back by 4-5 mm.

Fig. 22 shows how the hook is clamped with tweezers or a clamp, and the first hook is inserted under the free edge of the nail—only in a safe area that is not in contact with the nail bed. The ligature is stretched, and the second hook is inserted. The hook is inserted along path 1 along the nail fold, and when the nail reaches the ingrown point, the clamp is unwrapped along path 2 and placed on the nail.

Fig. 23 shows the installation of a staple without hooks using the adhesive method without stretching the staple. After the base is created, an indentation of 1-2 mm is made from the edges of the base and the ligature is bent upward with a tool to create tails by which the staple will be pressed against the nail and stretched along it during fixation. In this case, the center of the staple is fixed with composite at the zero point of deformation - point 1. One part of the staple is stretched by the tail to the extreme point of the nail plate, pressed, and fixed with composite at the point of contact with the nail - point 2. Similar manipulations are performed with the second part of the staple - the fixation point is point 3. Additional fixation points are installed on the remaining bends of the base - points 4 and 5. The excess ligature is bitten off and the edges of the ligature are completely covered with composite.

Fig. 24 shows the treatment of an ingrown and deformed nail using the claimed method according to Example 1.

Fig. 25 shows the treatment of staple-shaped nail deformation using the claimed method according to Example 2.

Fig. 26 shows the treatment of a deformed nail with onycholysis and a slipped nail bed according to Example 3.

Fig. 27 shows the treatment of a slipped nail bed due to chronic trauma from tight shoes according to Example 4.

Fig. 28 shows the treatment of an ingrown and deformed nail using the claimed method according to Example 5.

Implementation of the invention

After studying various flat spring shapes and conducting experiments on their operation, it was discovered that more curved lines, tending toward the classic omega, exhibit a more stable behavior. By combining their operating mechanism with that of straight spring lines, the brace was achieved with greater fixation on the sides of the nail plate, but also with greater force in the center, resulting in more controlled and safe operation of the corrective system on the nail. The brace exhibits these properties both with hook fixation (with rotational force) and without it (with adhesive).

When fixing a brace to correct a nail plate deformity or an ingrown nail, we determine the force of action depending on the method of fixing the brace: with hooks, there will be three forces of action - a lever, a spring, and rotation; a brace that does not have hooks will have two forces of action - a lever and a spring.

The spring in the brace is an M-shaped base. We can activate the spring by compressing it on the nail and deactivate it by releasing it. A reasonable degree of spring activation to maintain tension is 4-5 mm in length. When deactivated, the spring no longer maintains tension, but instead regenerates with each step. Passive activation and its degree will depend solely on the thickness of the plate, its elasticity, and the degree of load on the foot during a step. With passive activation, the spring cannot be overactivated, as its compression and release will only occur within the natural flexion of the nail plate.

The same base performs the functions of a lever when we place it on a curved nail, and here we can also activate this force, as well as increase/decrease the degree of activation or deactivate it altogether.

A reasonable degree of lever activation is an angle of approximately 15 degrees. The bracket is initially completely flat, but in areas of constant bending, it can be bent to adjust the angle of the bracket relative to the nail plate.

If the spring is made from the edge of the nail to the edge of the nail, then one section of the nail is subject to the action of two forces at once: the spring and the lever, which the spring itself becomes.

If necessary, the force can be divided between individual sections of the nail and a narrower base can be created with two ligature arms—the arms of the clamp. These arms allow us to adjust the leverage force, giving them varying degrees of intensity to suit the shape of the nail plate. The spring in this clamp has minimal force.

This ability to combine and separate physical forces gives unlimited possibilities for the application of this system.

The bracket can be made from an orthodontic ligature of medium elasticity - which can be deformed by an instrument, but still retains elasticity.

The bracket is made from a medium-elastic orthodontic ligature, which can be deformed with an instrument while maintaining its elasticity. The ligature can be shaped with double-ended or single-ended orthodontic round-nose pliers. The base of the bracket is shaped into an M-shape, with the curves of the outer parts of the base forming a semi-omega. This curvature of the ligature ensures a more secure and stable hold on the nail edges.

The base is tailored to the width of the nail plate being corrected, maintaining the shape of the bracket. The bracket is activated by compressing it 4-5 mm, after which the resulting bracket is secured to the patient's nail.

In this case, the brace can be fixed on the patient’s nail with one hook, two hooks and/or adhesive.

When securing a staple with two hooks, the first hook is inserted under the nail plate and the arm is curved to match the shape of the lateral edge of the nail so that the ligature follows the nail's curve. Similar manipulations are performed with the second hook, activating the lever and spring forces of the staple, compressing the spring by 4-5 mm and raising the levers by 4-5 mm. Then, clamp the hook with tweezers or a clamp and insert the first hook under the free edge of the nail where it is not attached to the nail bed, stretch the ligature, and insert the second hook. Insert the hook along path 1 as shown in Fig. 2 along the nail fold. Upon reaching the nail ingrown point, the staple is unfolded along path 2 as shown in Fig. 22 and placed on the nail. The staple is then secured with dental composite at the points of constant curvature.

When fixing the staple using the adhesive method without stretching the staple base, step back 1-2 mm from the edges of the base and bend the ligature upward with a tool to create tails, which will press the staple against the nail and stretch it during fixation. The center of the staple is fixed with composite at the zero point of deformation - point 1 as in Fig. 23. Then, one part of the staple is stretched by the tail to the extreme point of the nail plate and pressed, after which it is fixed with composite at the point of contact with the nail - point 2 as in Fig. 23. The staple is similarly fixed on the opposite side of the nail and at the point of contact with the second part of the staple - point 3, as in Fig. 23. The excess ligature is bitten off and the edges of the ligature are completely covered with composite.

The adhesive mounting can be designed as a loop, which provides a large contact area with the nail and secures the system.

In addition, the bracket can be fixed on one side with glue and on the other with a hook.

The use of the claimed method for correcting deformation or ingrown nails using a modified form of the bracket ensures versatility, as its area of use with any type of nail plate deformation is not limited.

Example 1

The patient was diagnosed with an ingrown and deformed nail and was treated with the stated method, using a stapler. The before and after treatment results are shown in Fig. 24.

Example 2

The patient was diagnosed with a staple-like nail deformity and was treated using the stated method, with a staple. The before and after treatment results are shown in Fig. 25.

Example 3

The patient was diagnosed with a deformed nail with onycholysis and a slipped nail bed. Treatment was performed using the stated method, including the placement of a staple. The before and after treatment results are shown in Fig. 26.

Example 4

The patient was diagnosed with a slipped nail bed due to chronic trauma from tight shoes and was treated with the stated method, including the placement of a brace. The before and after treatment results are shown in Fig. 27.

Example 5

The patient had an ingrown and deformed nail and was treated with the stated method, using a stapler. The before and after treatment results are shown in Fig. 28.

Claims (6)

1. A method for correcting a nail plate deformation and an ingrown nail, which includes forming a bracket and fixing it on the patient's nail, characterized in that the bracket is made from an orthodontic ligature with elasticity, then the base of the bracket is given an M-shape using double-ended or single-ended orthodontic round-nose pliers, wherein the bends of the extreme parts of the base are formed in the shape of a half-omega, wherein the base is made to fit the width of the nail plate being corrected, observing the specified shape of the bracket, the bracket is activated by squeezing it, after which the resulting bracket is fixed on the patient's nail. 2. The method according to paragraph 1, characterized in that the bracket is fixed on the patient’s nail with one hook and adhesive method, or with two hooks, or adhesive method. 3. The method according to claim 2, characterized in that when fixing the staple with two hooks, the first hook is inserted under the nail plate and a bend in the shoulder is formed in accordance with the shape of the lateral edge of the nail in such a way that the orthodontic ligature duplicates the bend of the nail, similar manipulations are performed with the second hook, the force of the lever of the staple is activated, squeezing it by 4-5 mm, after which the hook is clamped with tweezers or a clamp and the first hook is inserted under the free edge of the nail, where there is no adhesion to the nail bed, the ligature is stretched and the second hook is inserted, while the hook is inserted along trajectory 1, as in Fig. 2 along the ridge, and upon reaching the ingrowth point, the staple is unfolded along trajectory 2, as in Fig. 22, and placed on the nail, then the staple is fixed with a dental composite at the points of constant bending. 4. The method according to claim 2, characterized in that when fixing the staple using the adhesive method, 1-2 mm are retreated from the edges of the base and the orthodontic ligature is bent upwards with an instrument, forming tails, which are pressed against the nail and stretched along it at the moment of fixation, while the center of the staple is fixed with a composite at the zero point of deformation - point 1, as in Fig. 23, then one part of the staple is stretched by the tail to the extreme point of the nail plate and pressed, after which at the point of contact - point 2, as in Fig. 23 - with the nail it is fixed with a composite, the staple is similarly fixed on the opposite side of the nail and at the point of contact with the second part of the staple - point 3, as in Fig. 23, then the remaining bends of the staple base are additionally fixed, the excess ligature is bitten off and the edges of the ligature are covered with a composite. 5. The method according to paragraph 4, characterized in that the fastening for the adhesive installation can be made in the form of a loop. 6. The method according to paragraph 5, characterized in that the staple can be fixed on one side using an adhesive method, and on the other by means of a hook.