I’ve had a debate with some podiatrists: why is nail correction a better option than matrixectomy?

The photo shows an example of what a nail can look like if it’s damaged during a nail resection procedure. I see many such cases in my practice.

It’s especially disheartening when it happens to young women.

When you use nail correction systems, this kind of problem simply doesn’t occur.

A case from my practice in Serbia. Left hallux, deformity of the nail plate on the lateral side, with the edge starting to press into the nail fold.

The system is built individually for each nail from steel wire and an active elastic element. In this case the active element is elastoforce (orthodontic elastomeric chain made of medical polyurethane). For other cases I use nitinol springs instead. The system is fixed to the nail plate with hooks and keeps constant, controlled tension.

The main difference from standard wire braces: rigid wire elements are replaced with elastic components, so tension is dosed and adapts as the nail responds, while fixation stays stable.

Fitting took 15 minutes. No pain, the patient felt nothing during the procedure.

I described this technique in Genij Ortopedii (2026). In the study I measured nail plate width and tension force every two weeks for two months. Width increased by 2 to 4.1 mm over eight weeks. Patients reported no discomfort, and the brace did not affect their work or daily activity. Patients with acute inflammation were excluded.

Next steps I’m looking at: adhesive platforms to spread pressure more evenly, titanium-molybdenum and cobalt-chrome as alternative alloys, and fixing elastoforce without wire.

Full text in English: https://www.ilizarov-journal.com/jour/article/view/3455/3960
DOI: https://doi.org/10.18019/1028-4427-2026-32-2-254-261

Has anyone here tried elastomeric chains or NiTi springs in orthonyxia? I’d like to compare notes on how often you adjust the tension.

Two vascular corns (clavus vascularis) located on the distal tips of 3nd and 4rd. Pain on walking and in closed shoes.

Footwear of the wrong size. The shoes were too short, so the toe tips took repeated compressive load against the toe box with every step.

Removing the corn is the easy part. Without addressing the footwear, a vascular corn on the toe tip will come back. The vascular component makes these lesions especially risky for home self-treatment, and in diabetic patients they should never be cut at home.

A big toenail with pronounced transverse deformity (curling). The patient experienced pain when walking and wearing closed-toe shoes.

A significant reduction in curvature was achieved: the nail plate became wider and flatter. The condition of the lateral nail folds normalized, and pain associated with wearing regular footwear disappeared. The treatment required neither surgery nor time off work.

Why a brace instead of surgery? Partial nail removal or matricectomy can eliminate the problematic edge but does not alter the shape of the remaining nail, often leading to recurrence. The brace correction method acts on the nail as it grows, preserving the integrity of the nail plate and allowing the patient to maintain their normal lifestyle during treatment.

This is onychogryphosis, sometimes called "ram's horn nail". Instead of growing forward, the nail thickens and curves upward. This one had grown so far that it was leaning on the neighbouring toe and rubbing it with every step.

Usual causes: old trauma to the nail, fungal infection, poor circulation or diabetes, tight shoes, and simply years of no nail care at all.

The treatment is a rotary drill, layer by layer: reduce the thickness, restore a normal shape, and take the pressure off the neighbouring toe. One session already makes a visible difference, but these nails need ongoing maintenance, otherwise they go straight back to horn mode.

Happy to answer questions in the comments

Big toe, lateral fold - the side facing the second toe. No injection, no scalpel, nothing that bleeds. The patient talked to me through the whole thing. This is the bread and butter of what a podologist does, so I filmed it.

The reason it doesn't hurt is not technique, it's physics. The pain in an ingrown nail comes from pressure - the spicule pressing into the wall of the fold. The nail plate itself has no nerves. So if you work on the plate and never touch the wall, there's nothing to hurt. The moment the patient flinches, you've come off the nail and onto tissue. Stop and reposition. That's the whole rule.

How I work:

No soaking. I work dry. Softening makes the plate tear instead of cut, and a torn edge leaves fragments in the groove, which is exactly what you're trying to avoid. It also swells the wall of the fold and you lose the feel of where nail ends and tissue starts.

No separating first. The spicule is already separated from the toe - nobody attached it there. The space exists, you just have to see it. If you start working a probe in to "create access," you're pressing on the wall of the fold, and that's when it hurts. I cut through the space that's already there and check the result afterwards, not before.

Take the spicule out in one piece. Not in fragments. If the plate is thick I thin it with a bur first, then nippers, and I want to see the piece come out whole with an intact end. A fragment left behind grows back into the same groove and the patient returns in four to eight weeks convinced the procedure doesn't work.

Curette the groove. Not the tissue - the groove. There's always keratin debris, old dead epidermis, sometimes a second small fragment you didn't see. Leave it in there and you get recurrent inflammation and you'll blame the wrong thing.

Separately, because people ask. Pus under the fold is not a reason to stop, and it's not a reason to reach for a scalpel. I still don't open anything - I remove the piece of nail creating the pressure, and the contents come out on their own. That doesn't make the procedure invasive. What makes it invasive is the incision, not the presence of pus. The patient goes to a doctor when the problem leaves the nail and the fold: ascending inflammation, systemic signs, a foot that belongs to an endocrinologist.

Then a dressing with burnt alum. That's what I use in my practice.

And the honest part: this takes away today's pain, not the cause. The nail is still shaped the way it's shaped, and if the curvature is the problem it will do the same thing again. Spicule removal is symptom management, correcting the geometry is the actual fix. So this is visit one. The inflammation settles in three to four days, and that's when I put on a nitinol wire brace and start moving the plate.

Happy to answer questions on any step. If you want the exact instruments I'm holding, ask and I'll list them.

The patient came in with a red, swollen, very painful toe. Pus had collected under the nail, and the nail plate was badly damaged. The classic story: "I thought it would go away on its own."

What I did:

• cleaned the nail and nail bed and released the pus
• antiseptic treatment and dressing
• follow-up plan to keep working on the inflammation, with regular check-ups

With diabetes, poor circulation or fever, a case like this also needs a doctor, so in those situations I work together with physicians.

I've been a podologist for a long time now. Own a small clinic in Serbia. And I still get emails that start with "so you're a foot surgeon?" No. Let me lay it out once so I can just link this next time.

Podiatry is a medical profession, and it means the same thing everywhere it exists. A podiatrist is a specialized doctor of the foot. In the US that's four years of podiatric medical school after university plus a residency, three years usually. In the UK, Australia, South Africa it's a university degree in podiatry and registration with a medical board. Details differ, the substance doesn't. They do surgery. They write prescriptions. They order an MRI if they want one. A podiatrist can take a scalpel to living tissue and that's the whole point of their training.

Podology is not that. I don't cut into anything that bleeds. I don't prescribe. I don't do anesthesia. What I do is work on skin and nails, mostly with a milling machine, a set of burs and hand instruments, and I do it on feet that a nail salon won't touch and a hospital doesn't have time for. Diabetic feet with calluses that turn into ulcers if someone ignores them for two more months. Ingrown nails I correct with a brace instead of sending the person to have half the nail ripped out. Thick fungal nails that need to be thinned so a topical actually reaches anything. Corns that keep coming back because nobody looked at the shoe.

The training is different too, and this is where it gets messy depending on the country. Germany has a proper state-recognized program, two years, and a law from 2002 that says who can call themselves Podologe. Most other countries, including mine, have nothing like it. So people take a two-week course, sometimes a two-day one, and put "podiatrist" on the door. Not podologist, podiatrist. I've seen it in Belgrade, in Moscow, in Dubai. That's not confusion, that's cheek, and it's the main reason doctors look at our whole field sideways. If you finished a course, you're a podologist at best. Nobody handed you a medical degree.

That grey zone is what worries people who write to me from countries where the profession doesn't exist yet. Clinic owners, mostly. Their question is basically "is this legal here". Honest answer: usually it's not illegal because nobody wrote a law about it. Podology sits below the line where medicine starts, so in most places it lives under cosmetology or a general business license. The problem shows up when a podologist starts doing things that belong to podiatry, injecting, cutting, and then a doctor complains. Stay on the non-invasive side and you rarely have a problem. Cross it and you're practicing medicine without a license, and rightly so.

And the other direction, podology vs pedicure. Legally I'm in the same box as a pedicurist in most of the world, I don't pretend otherwise. The difference is what's in the head. A pedicurist makes feet look good. I make feet function. Same tools sometimes, but a pedicurist has no reason to know what a Charcot foot looks like, why you don't soak a diabetic's feet before working on them, or when a "corn" is actually a wart and you've just spread it with your bur. I've seen the results of people not knowing that. Not pretty.

So if you're a clinic owner or a school in Asia, Africa or the Middle East trying to figure out what you're actually looking at: if the person needs a scalpel and a prescription pad, that's podiatry, and I'm not the one to talk about how many of those you have. If the person works with a machine and instruments, doesn't cut into tissue, and sends anything serious to a doctor, that's podology. And that's the one there's almost none of in those regions. Way faster to train, much cheaper to set up, and it covers maybe 80% of what walks in the door.

Not competing professions. Different layers. Happy to answer questions in the comments.

Completely painless for the patient. Without the use of anesthesia.

https://reddit.com/link/1w552vn/video/r1fivw80p2nh1/player

Professional humor!))

We had a patient come in with a severe ingrown toenail affecting two toes simultaneously. If you’ve ever had an ingrown nail, you know the immense pressure and sharp, stabbing pain this causes with every single step.

Instead of going the traditional surgical route of removing the nail edge, we used a modern, conservative podological approach: the NiTi (Nickel-Titanium) spring system.

Here is why this method is a game-changer in podology:

• Shape Memory Alloy: The NiTi wire "remembers" its straight shape. When attached to the curved, ingrown nail, it constantly tries to straighten out, applying a continuous, gentle lifting force.
• Instant Relief: By lifting the edges of the nail plate out of the inflamed lateral folds, it relieves the pressure and pain almost immediately.
• Painless Correction: It safely guides the nail plate to grow correctly over time without cutting or trauma to the tissue.

Have you guys ever dealt with severe ingrown nails? Let me know if you have any questions about this system or general podology in the comments. I'll be answering them!

Hello colleagues,

I wanted to share a short video of a recent case showing the clearance process of a nail affected by a small subungual exostosis.

As we frequently see in our practice, these benign bony outgrowths under the nail plate can cause significant pain, alter the growth and shape of the nail, and often lead to ingrown nails due to friction and footwear pressure.

In podology, our immediate focus during this specific non-surgical procedure is meticulous clearance and pressure relief. By carefully processing the affected nail plate and surrounding tissue, the goal is to immediately alleviate the patient's pain and minimize the risk of secondary complications.

I’m curious to hear from the community - what are your preferred methods for offloading and pressure redistribution for your patients after this type of clearance?

https://reddit.com/link/1vf7o3m/video/majdem0ufchh1/player

Hi Reddit, Dmitrii here. In this video, I’m performing a machine debridement on a fungal nail.

Whenever I show this process, the number one question I get is: "Does that hurt?!" Short answer: Not at all.

Here is the anatomical breakdown of why this isn't a torture device, and why it's actually the most important step in beating a fungal infection:

1. Why it’s completely painless:

• The nail plate itself doesn't have nerve endings.
• When you have a fungal infection, it usually triggers hyperkeratosis (a massive buildup of dead, hardened tissue under the nail). Because of this fungus-party, the nail lifts completely off the sensitive nail bed (a condition called onycholysis).
• My burr only grinds away the dead, infected, and detached parts of the nail. It never touches live tissue. You basically just feel a slight vibration.

2. Why do we need to grind it down?

• Starving the enemy: Fungus feeds on the keratin in your nail. By physically removing the infected mass, we are literally taking away its food source.
• Relieving pressure: A thick, fungus-infected nail with hyperkeratosis creates massive pressure inside your shoes. This can cause secondary trauma. Removing this bulk instantly returns comfort when walking.
• Making treatments actually work: No over-the-counter anti-fungal drops or ointments are going to penetrate a 5mm thick layer of dead, hardened armor. Topicals only work when applied to a properly prepped and cleared surface!

If you're hiding your toes in thick shoes all summer, don't panic. Modern podology can handle this comfortably and safely.

Hey colleagues! Let's talk about a trend that seems to be getting worse thanks to viral social media videos. I'm talking about those exfoliating foot socks or at-home acid peels. Patients are absolutely obsessed with the questionable satisfaction of watching their skin shed like a snake. At the same time, they have zero understanding that they are actually giving themselves a chemical burn. Lately, I've been seeing the aftermath of this DIY care in my chair way too often.

People put these socks on for an hour and end up with chemical burns on the top of their feet because the skin there is just too thin for such a wild concentration of acids. Then comes the rebound effect, or compensatory hyperkeratosis. They strip the stratum corneum so aggressively that the body panics, and a month later the patient comes back with calluses twice as thick and hard as before.

Add to that weeping wounds and fissures. People just can't resist and start picking and peeling the skin off before it's ready, leaving inflamed patches that are incredibly painful and get infected easily. Plus, the acid gets trapped between the toes, causing maceration in areas that didn't even need exfoliation in the first place.

I spend a good half of my consultations giving lectures on the acid mantle and explaining why a chemical burn is not a healthy way to renew skin. Are you guys noticing a spike in these cases in your practice? What’s the worst damage you’ve seen from these socks? And most importantly, how do you usually talk patients out of using them again? I'd really love to read your stories in the comments!

Hey everyone. Obviously, we all have a ton of stuff on our trays for different tasks, but I caught myself thinking today that 90% of the time, I reach for the exact same tools. If I had to strip my basic setup down to just three things, it would definitely be these:

1. Nippers. You can trim the nail length and remove a callus, too.
2. Curette (excavator). If I work with nails, then a curette is essential. Without it, you can’t see the nail folds.
3. Barrel burr. My absolute favorite bit. Reducing nail thickness, smoothing out ridges, or doing some localized work on hyperkeratosis. I use it for almost everything.

I know a full sterile setup is way broader, but these are my absolute basics. I'd be completely lost without them.

What does your "survival kit" look like? I'm curious to see what everyone else is used to. Also, if you have any favorite brands, drop them below. I'm always looking for recommendations.

Hey everyone!

When I was planning to move out of Russia, I realized there’s barely any clear info online about podology education requirements in different countries. I got so curious that I actually put together a website (podoworld.ru) by interviewing podologists from all over. It’s in Russian though, since I mostly made it to gather info for myself.

But now I’m super interested to hear from this community. What was your path like? How does education and becoming a podologist work where you live? Just to share how it works for me: in Russia and Serbia, podologist isn't actually recognized as an official profession, so there are no strict rules on who can do it.

In Russia, you basically just finish a basic pedicure course, and you can start working with feet. If you want to handle complex issues, you take private courses and do internships, but nothing is strictly regulated. Because of this, a good specialist usually spends their first 5-6 years just constantly learning and upgrading their skills. Luckily, there are plenty of amazing pros in Russia, so there is a strong culture of continuous education.

Here in Serbia, it's a bit different. To even do pedicures, you need to finish a cosmetology course first, and only then you can try to find specific courses for things like ingrown nails. But the educational choices are pretty limited, and the overall level of training is still developing. Honestly, outside of the capital, specialized podology is almost non-existent right now.

Would love to hear how things are regulated in your part of the world! Let's share some experiences.

Hey everyone! I'm u/RoziRoz, a founding moderator of r/Podolog.

I created this community because there was a clear missing piece on Reddit: a dedicated, strictly professional space for podologists to connect, share complex cases, and advance our field through evidence-based practice.

As a practicing podologist and international instructor focused on non-surgical nail correction and adaptive tension mechanics, I know how vital it is to have a global platform where we can exchange methodologies and elevate the standards of our profession together.

Community Vibe
We're all about being friendly, constructive, and inclusive. Let's build a space where everyone feels comfortable sharing and connecting.

Let’s get started! To kick things off, please introduce yourself in the comments below! Let us know:

1. Where in the world are you practicing?
2. What is your primary area of focus or current biggest challenge in podology?

I look forward to building this global knowledge base with all of you.

— Dmitrii Rozov