Members do not see these Ads. Sign Up.

Hi All,

I have a patient, 50 y.o. healthy female, who has had persistent pain and nail issues on her Right hallux for aprox 3 years. The patient described as a recurring 'ingrown nail'. Previously being managed by a GP.

12 months ago, (Sorry details are vague, as pt has trouble recalling)
The patient reported having surgery with GP which she though was to 'remove the whole nail due to involuted edges'.
Some sort of total nail avulsion was performed where sutures were used.
?cauterisation.

The nail has now regrown, though I am 95% sure there is a subungual exostosis of the distal phalanx. The distal edge of the nail hits the bulge and causes pressure and pain.

I have sent for X-rays for Dx, but am interested in other pods conservative and surgical management.

Is sugical removal the gold standard response?

Thanks,

Sally

 

Should XR confirm so, yes.

LL

 

Thanks LL

 

Most likely an osteochondroma...easily removed surgically. Otherwise if she is unfit for bone surgery for any reason then total nail avulsion should work. Good luck!

 

Sally,


"Some sort of total nail avulsion was performed where sutures were used.
?cauterisation. "

Could have been a Zadek or Winograd procedure - but with regrowth sounds rather unsuccessful....

This sounds very, even without the x-ray, much like a sub-ungal exostosis.

I have one the other day. It was a painful distal medial tip of the hallux.
There was a long history of the nail growing and 'riding' up....

I resected back around to see if this was mearly hyperkeratosis as have seen this before - but clearly found this to be bony (needless to say under anaesthesia!)

XR - lovely exostosis

Quick trip to theatre
Remove nail
Cut off the bony prominence
Bell's Rasp it smooth
Allow nail to grow again

2 months later - lovely healed and nail beginning to grow normally .... very happy patient !

Regards,

DrScouse

 

You could give Rothbart's Proprioceptive insoles a go!!!