OSCE — recurrent ingrown toenail with granulation tissue

Brief (to candidate)

A 20-year-old has recurrent painful right hallux nail-fold disease with hypertrophic granulation after two avulsions. Tight boots; rounds nail corners. Stage the disease, manage now, and plan definitive prevention of recurrence.

Candidate instructions

1. History: footwear, cutting technique, diabetes, prior procedures.
2. Stage the onychocryptosis.
3. Immediate management including antibiotic decision.
4. Explain definitive procedure and role of phenol.
5. Prevention counselling.
6. Safety checks before procedure.

Examiner checklist

Model key actions

• Stage correctly; do not repeat temporary avulsion alone as the long-term plan.^[1]
• Explain phenol ablates lateral matrix to cut recurrence.^[4]
• Teach nail-cutting and footwear prevention.

Common errors

• Antibiotics forever without mechanical plan.
• Total nail ablation for first mild episode.
• Ignoring vascular/diabetes risk.
• Rounding-corner cutting advice (wrong).