Orthonyxia: the sliding block technique

In February, we told you about one of the practices of chiropodists: orthonyxia. As a reminder, this technique consists of correcting the shape of the nail and reducing conflicts between the nail and the grooves (during ingrown toenails). We also presented a technique regularly used by professionals, titanium wire orthonyxia. However, other techniques exist, such as orthonyxia with sliding studs.

The different types of orthonyxia

There are several types of orthonyxia, which leaves it to each chiropodist to choose their practice according to their professional identity, ideas and creativity. Here are some examples:

- Orthonyxias with steel wire staples
- Tongue orthonyxias
- Orthonyxies in elastomer chains
- Bacquart tongue orthonyxies - Titanium wire orthonyxies
- Orthonyxias in VHO loop
- Osthold (new method of May 19, 2020)
- And orthonyxies with sliding studs which we are going to talk about today!

Main contraindications...

The installation of these nail orthoses has contraindications in certain cases. Indeed, the installation of an orthonyxia regardless of the technique may be contraindicated if a case of nail fungus, infections, major ingrown nails, friable nails or even subungual hematomas is proven.

However, in cases where orthonyxia might be contraindicated, it is up to you, as a healthcare professional, to adapt to the patient and judge whether it is useful to perform orthonyxia. Particularly if the main reason for the consultation is a persistent and very painful ingrown toenail for your patient.

As you can see, today we are going to talk to you in detail about orthonyxia with the sliding plot technique. And as in the last article, we have made a tutorial video to illustrate our point:

The necessary materials, step by step

Click on the bold and underlined words to access the product sheets:

Step #1 - Preparation of the nail and possible removal of a previous orthonyxia using cutting nail pliers.

Step #2 - Removing resin residue and milling the nail plate (etching) using a handpiece and a tungsten carbide nail drill .

Step #3 - Suction of the grooves to ensure the total absence of residue. Discover our suction micromotors .

Step #4 - Degrease the nail using nail polish remover, nail cleanser or equivalent such as modified alcohol 70% .

Step #5 - Making notches on each side of the nail with a #1 gouge blade  in order to strengthen the grip of the resin pads.

Step #6 - Application of bonding on the nail ( Bonding n°1 or Bonding n°2 ) at the level of the future resin studs using a brush spatula , bonding brushes and a clear glass cup for bonding .

Step #7 - Photopolymerization of the bonding for 10 seconds using an LED photopolymerizing lamp .

Step #8 - Placement of a first hard resin pad with a titanium wire . The diameter of the wire depends on the power you want to give to the orthonyxia.

Here is a selection of hard resins:

Step #9 - Photopolymerize the plot for 40 seconds. Repeat for an additional 40 seconds if necessary.

Step #10 - Cut the titanium wire to the appropriate length so that the wire does not enter the opposite groove (leave about 2mm of margin).

Step #11 - Model the hard resin on the sliding block tunnel boring machine .

Step 12 - Apply the second resin block and the tunnel boring machine in the furrow opposite the first block.

Step #13 - Photopolymerization of the 2nd plot for 40 seconds.

Step #14 - Remove the tunnel boring machine from the pad.

Step #15 - Insert the titanium wire into the second stud using pliers. At the next appointment, repeat this step to remove the titanium wire from the stud, resize and reinsert it so that the pressure is renewed on the nail.

Step #16 - Fill the hole left by the instrument inside the 2nd plot with a flow resin (liquid). Here is a selection of flow resins:

Step #17 - Light cure for 40 seconds.

Step #18 - Check and remove any resin residue in the grooves to avoid potential injury from the studs. Check that the titanium wire does not protrude from the 2 studs.

Find all the products and materials needed to create orthonyxies on our website:

The best approach?

Today, among the many existing techniques, none has been proven to be the best. However, treating ingrown toenails using the orthonyxia technique can avoid painful surgical intervention.

In fact, a study was conducted by the American Podiatric Medical Association on 41 patients.

On one side, 21 patients received surgery to treat their ingrown toenails. On the other side, 20 other patients were treated with the orthonyxia method. The pain due to the treatment was significantly lower in the group that received orthonyxia than those receiving surgery.

In addition, they could also put on shoes quickly without any noticeable pain.

Finally, in the group that received surgery, four recurrences were observed. They therefore concluded that orthopedic treatment could be a good conservative alternative to operative procedures.