Here's a mind game I play with patients. After I explain to patients what a matrixectomy is, etc, I tell them, "To do this, I need to place an injection around your toe. Is that ok?" Obviously, they say yes. But because of that, everything that happens next is because they told me to do it. I have no idea if there's any real basis in human psychology for this, but I think that tiny interaction sort of steels their mind for the ordeal of the injection (which really is over in <10 sec anyway).
When that doesn't work, when you have an uncooperative or hysterical patient, you have to be a bit of a sociopath. Here's the positioning.
-Exam chair reclined all the way. Parent/caregiver leaning over the torso, as necessary.
-Doctor seated aside the exam chair, ipsilateral to the problem toe, back to the pt, looking down on the foot.
-Lean aside the leg, arm over the knee, to restrain the knee.
-Non-dominant hand holds the foot firmly in maximum plantarflexion and supination. As we know, this is an unstable position for the ankle, and if the patient attempts to withdraw their leg, they will stress the lateral colateral ligaments self-inflicting pain on themselves.
-Inject. They'll twitch their hallux but you can hold your target injection sites at the MTPJ steady.
-As the toe goes numb, pt regains their sanity. If not, be prepared to repeat this positioning when doing the matrixectomy.
Using this technique, I haven't taken an ingrown to the OR since 2019, and never will again. If the parent finds this approach barbaric, remind them of the hospital copays and time off required of them if the pt is to undergo sedation anesthesia.
