Alinia H, Taheri A, Feldman SR. New taping method for ingrown toenail [eletter]. Ann Fam Med. 29 January 2015.

Table 1: Limitations of study and treatment method, consideration and suggestion

Possible limitations of the study / Considerations
The authors reported only the average follow-up period. / Confidence in cure rate depends on length of follow-up period, and it is unclear how many of subjects had long term follow-up periods. Reporting median and range of the follow up period as well as mean can be more informative.
There is no control group for this study to evaluate the improvement rate and the time needed to relieve the pain / Ingrown toenail may be a self-limiting condition in mild cases by elimination of extrinsic causing agents and the pain may be resolved by wound healing. The study group should be compared with a “No treatment” control group (or changing the life style) to compare the improvement rate, and the time needed for relieving the pain.
In this study there are lack of data about the severity of the ingrown toenail and presence of hyper-curvature and granulation in patients who achieved response. / Conservative treatment is usually considered for mild to moderate cases1. Knowing about the response rate in different stages helps the care givers to choose a proper technic for their patients.
Previous surgery may be a sign of worse disease / The role of surgery as a risk factor for failure may or may not be directly related to the surgery. It may be that previous surgery is a marker for patients with worse disease.
Limitations of the methodology / Suggestion
Patient needs repetitive renovation of the taping in chronic relapsing disease such as ingrown toenail and lack of adherence is expected. The long time needed to alleviate the pain (about a week) may also cause cessation of treatment. / For mild cases the conservative gutter technic without anesthesia may relieve the pain faster, patients are less involved in their treatment and the response rate is higher 5 and Simple (partial) nail avulsion combined with phenol ablation remains the treatment of choice with low recurrence rate for more severe cases3.
Granulation tissue and hyperhidrosis may lower tape adhesion and the tape may not remain stuck on this area. Using anchor taping may also exacerbate hyperhidrosis and prevent evaporation. / Use of mastisol has been suggested to make the skin more sticky2.

References:

1. Heidelbaugh JJ, Lee H. Management of the ingrown toenail. Am Fam Physician. 2009 Feb 15;79(4):303-8.

2. Haneke E. Controversies in the treatment of ingrown nails. Dermatol Res Pract. 2012;2012:783924. doi: 10.1155/2012/783924. Epub 2012 May 20.

3. Park DH, Singh D. The management of ingrowing toenails. BMJ. 2012 Apr 3;344:e2089. doi: 10.1136/bmj.e2089.

4. Tsunoda M, Tsunoda K. Patient-controlled taping for the treatment of ingrown toenails. Ann Fam Med. 2014 Nov-Dec;12(6):553-5. doi: 10.1370/afm.1712.

5. Taheri A, Mansoori P, Alinia H, Lewallen R, Feldman SR. A Conservative Method to Gutter Splint Ingrown Toenails. JAMA Dermatol. 2014 Dec 1;150(12):1359-1360. doi: 10.1001/jamadermatol.2014.1757.

Figure 1: Taping method and the mechanism of action

In this method while the author hold the tape at the points A and B with the index and thumb of one hand, stretches the tape with the other hand until it reaches to the point C (Black arrow). This stretch causes a force toward the center of stretched part (1 cm), pulling the nail fold away from the nail plate. (Red arrows)