Pathologie : L’ongle incarné

par

L’ongle incarné est une affection causée par une croissance excessive de l’ongle qui pénètre sous la peau, à l’origine d’un conflit entre lame et tissu cutané périphérique, source de douleur, d’inflammation et d’impotence fonctionnelle.

L’ongle incarné est dans la majorité des cas une affection du gros orteil.

 

I-ETIOLOGIES

Ces facteurs sont nombreux, variés et souvent associés entre eux :

• Prédisposition familiale ou génétique responsable d’une malformation de l’ongle.
• Chaussage inadapté (chaussures serrées).
• Prise de certains médicaments (ciclosporine, rétinoïdes, antirétroviraux, anticancéreux).
• Modifications osseuses secondaires à l’arthrose.
• Excroissance de la peau qui se développe sous l’ongle.

II- SIGNES CLINIQUES

– Sur le côté (incarnation latérale) : le bourrelet sur le côté de l’ongle est douloureux à la pression et à la marche.
– A l’avant (incarnation antérieure) : l’ongle pénètre dans la chair sur l’avant, il est impossible de le couper et il finit souvent par tomber.

On retrouvera également :
• Douleur, rougeur et gonflement (inflammation), qui précèdent parfois l’infection avec formation d’un panaris ou d’un érysipèle (infection plus sérieuse des tissus du pied et/ou de la jambe, provoquée par un streptocoque).
• Épaississement d’un bourrelet de peau sur le bord d’un ongle (hypertrophie d’un bourrelet latéral).
• Excroissance de peau rouge (granulome pyogénique ou botryomycome).

III-TRAITEMENTS

Soulager la douleur :
– Pose de mèches aux bords distaux,
– Coupe large pour retirer l’éperon unguéal,

Il est possible d’avoir recours à l’orthonyxie en prévention de récidive: c’est une orthèse d’ongle qui permet par son effet ressort de corriger les problèmes de déformation de l’ongle causant des conflits entre la peau et l’ongle et provoquant alors des douleurs. Si l’indolence est rapidement obtenue, le plus souvent dès sa pose, il faut des mois pour modifier la courbure unguéale. Une interruption trop rapide est suivie de récidive.

Dans le cas d’une surinfection, le médecin prescrira un traitement antibiotique local (Fucidine) et des pansements.

La chirurgie (cas extrême) se pratique sous anesthésie locale. Il s’agit de la résection au bloc opératoire et au bistouri d’une partie de bourrelet cutané latéral et de la partie latérale de l’ongle et de la matrice correspondante : le chirurgien enlève toute la zone atteinte, qu’elle soit cutanée ou phanérienne (le coté de l’ongle avec sa matrice correspondante).

IV-COMMENT EVITER LES ONGLES INCARNES

  • Couper les ongles d’orteil bien droits et laisser les coins légèrement plus longs. Porter des chaussures suffisamment larges pour ne pas compresser les orteils et abîmer les ongles.
  • L’utilisation orthodonyxie est également conseillé dans le cas d’ongle incarné récidivant.
  • Les personnes âgées, celles qui ont des problèmes de circulation ou qui sont diabétiques doivent être très vigilantes quant aux soins à donner à leurs pieds. Elles devraient faire examiner leurs pieds par leur podologue 1 à 2 fois par ans, en plus d’avoir une bonne hygiène des pieds et de les examiner tous les jours.

 

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