Subungual Exostosis of the Toes

NewsBot · Oct 26, 2013

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Subungual Exostosis of the Toes: A Systematic Review
Mark P. DaCambra MD, MSc, Sumit K. Gupta MD, Fabio Ferri-de-Barros MD, MSc
Clinical Orthopaedics and Related Research® October 2013

Background
Subungual exostosis is a relatively common benign bone tumor that occurs in the distal phalanges of the toes and can be a source of pain and nail deformity. There is controversy about the treatment of these lesions and there are few studies that have synthesized what is known and provided meaningful information on treatment.

Questions/purposes
We performed a systematic review to address the following questions: (1) What is the best surgical approach for excising these lesions? (2) What is the age range, sex distribution, and presenting symptoms of subungual exostoses and which toe is most frequently affected? (3) What complications arise from treatment?

Methods
Two authors independently searched multiple databases (Medline, 1950–May 2013; Cochrane EBM database, and EMBASE, 1980–May 2013 provided by OVID; ACP Journal Club, 2003–May 2013; CINAHL by EBSCO, 1937–May 2013; and PubMed by NLM, 1940–May 2013), and key words were chosen to achieve a broad search strategy. We included studies on the management of toe exostoses with > 10 cases and we excluded studies that reported on upper extremity exostoses or osteochondromas. Demographic and treatment data were collected from each article by two independent authors and collated. A total of 124 abstracts were screened, and 116 articles were reviewed in full, of which 13 met the inclusion criteria.

Results
Complete marginal excision through a fish mouth incision protecting the nail led to a recurrence rate of 4% and satisfactory clinical results, defined as no requirement for postoperative intervention and a satisfactory clinical appearance in 73%. Most studies provided incomplete descriptions of specific surgical techniques used. Fifty-five percent of the patients were younger than 18 years of age. A history of toe trauma before diagnosis was present in approximately 30% of the cases. Delayed diagnosis occurred in approximately 10% of the cases and onychodystrophy occurred in more than 10%.

Conclusions
There is weak evidence to guide management of subungual exostosis. Adequate wound management postexcision aiming to minimize disruption to the nail bed and matrix may prevent onychodystrophy, which is a common complication of treatment.
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Admin2 · Oct 26, 2013

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NewsBot · Jan 20, 2016

Surgical treatment of nail bed subungual exostosis.
Malkoc M et al
Singapore Med J. 2015 Dec 14

INTRODUCTION:
Subungual exostosis (SE) is a bony overgrowth permanently attached to the tip of the distal phalanx. Its pathology is not exactly the same as exostosis in osteocartilaginous tumour types; instead, it mainly involves the overgrowth of normal bone, which may present beneath the toe nail or on the sides of the toe. This study aimed to report the results of the surgical treatment of cases in which the diagnosis of SE was delayed (the condition was initially considered to be another pathology affecting a different nail or the terminal toe).
METHODS:
A total of 17 patients (12 female, 5 male) were included in the study. They underwent surgery for SE removal between December 2009 and October 2012. Their mean age was 21.3 ? 4.4 (range 14-29) years, and the mean follow-up period was 27.1 ? 7.8 (range 18-45) months. All surgical resections were performed by the same surgeon, using the same surgical technique, with the patient under digital anaesthesia. The patients were evaluated pre- and postoperatively (on the first and sixth week, the first year and the last follow-up visit) using the American Orthopaedic Foot and Ankle Society questionnaire and the Visual Analogue Scale score.
RESULTS:
Clinical or radiological recurrence was not observed in any of the patients during the follow-up period. Four patients had superficial infections, which were treated using appropriate antibiotic therapies.
CONCLUSION:
As SE is a benign lesion that is uncommon, its diagnosis may be delayed. Radiography may be useful in the differential diagnosis of SE.
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NewsBot · Apr 30, 2018

Subungual exostosis and subungual osteochondromas: a description of 25 cases.
Göktay F et al
Int J Dermatol. 2018 Apr 27. doi: 10.1111/ijd.14003.

BACKGROUND:
Subungual exostosis (SE) and subungual osteochondroma (SO) are an uncommon, benign tumor of the distal phalanx. The purpose of this retrospective study was to evaluate clinical, demographical, and radiological features; treatment modalities; and follow-up results in SE and SO cases.

METHODS:
Twenty-five cases were confirmed histopathologically as SE or SO. At the time of admission, clinical data were obtained on the age and sex of the patient, duration of symptoms, presence of pain, previous diagnoses and treatments, concomitant systemic diseases, family history, lesional localization, clinical and radiological features of the lesion, surgical treatment methods, and duration of follow-up.

RESULTS:
There were 14 patients in the SE group and 11 patients in the SO group. There was no statistically significant difference in gender, age, duration of symptoms, or pain between the two groups. Regarding the locations of the lesions, two (14.28%) were on the hands, 12 (85.72%) lesions were on the toes, 11 (91.67%) of which were on the great toe, and one (8.33%) was on the small toe of the left foot in the SE group. All the osteochondroma lesions were located on the toes. In five (45%) cases, the lesion was on the great toe. Two patients had residual lesions in the SE group. Recurrence occurred in one case in the SO group.

CONCLUSIONS:
Clinically and histopathologically, SE and SO appear to be two different entities. When diagnosed correctly and treated appropriately, the lesions have good functional and cosmetic results, as well as a very low recurrence rate.
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NewsBot · Aug 31, 2018

Subungual Exostosis.
Laura Pérez-Palma, María Cristina Manzanares-Céspedes, and Enrique Giralt de Veciana (2018)
Journal of the American Podiatric Medical Association: July 2018, Vol. 108, No. 4, pp. 320-

Background: The coexistence of deformity of the nail bed and subungual exostosis (SE) is a frequent finding in podiatric practice in the fourth and fifth decades of life. However, it has been described by other specialists as being an uncommon osteocartilaginous tumor most prevalent during the second and third decades of life. This study attempts to determine the causes of this discrepancy.

Methods: Two authors independently conducted a systematic bibliographic review in multiple databases, podiatry sources and others, and key words were chosen to achieve a broad search strategy. Studies reporting on epidemiology and treatment of SE lesions in lower extremities in ten or more patients were selected. Initially, 197 articles were identified through database screening, with 23 meeting all inclusion and exclusion criteria. Seven articles with the ages of all of the patients were included in the analysis of age data. A comparison was then made between the diagnostic criteria for the selected 23 articles.

Results: Model results reveal that, although there are some significant differences between individual studies, the main factor tested (patient's age) was clearly significant (F1,5.2 = 78.12, P < .001), showing that studies coming from the podiatry speciality were conducted on individuals with a mean age of 37 years higher than in studies from other specialties. Clinical and radiologic characteristics and treatment described in the podiatry literature also contrast with those in other specialties.

Conclusions: The SE described by podiatrists, in accordance with the parameters of true exostosis, is different from Dupuytren's SE and should be considered as a different pathologic entity. The authors are working on its histologic identification.
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NewsBot · Mar 23, 2020

Subungual exostosis - treatment results with preservation of the nail bed.
Pascoal D, Balacó I, Alves C, Cardoso PS, Ling TP, Matos G.
J Pediatr Orthop B. 2020 Mar 16

Subungual exostosis is a rare benign osteocartilaginous tumor, of unknown etiology, that affects the subungual part of the distal phalanx and predominantly affects adolescent females. The objective of this study is to evaluate the results of surgical treatment of subungual exostosis in pediatric patients by means of surgical excision and nail preservation. We present a retrospective study, including pediatric patients with subungual exostosis who underwent surgical treatment in a single institution, over a 6-year period, We describe the surgical technique used, the characteristics of the patients and lesions, and evaluate the results obtained in terms of function, satisfaction and complications. Thirteen patients were included in this study, seven female (54%) and six male (46%), median age 11 years old. The most common location was the hallux, in eight patients (73%). Patients had good functional results with a median American Orthopedic Foot & Ankle Society score of 100 [80; 100] and a median personal satisfaction score of 9. The median follow-up was 30 [3;68] months. In our patients, subungual excision with nail bed preservation, allows a good balance between the radical excision of the exostosis and the preservation of the natural protection granted by the native nail, yielding good functional results and patient satisfaction.
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NewsBot · Oct 25, 2023

The Influence of Clinical Factors on Treatment Outcome and a Recurrence of Surgically Removed Protruded Subungual Osteochondroma and Subungual Exostosis
Mikołaj Dąbrowski et al
J Clin Med. 2023 Oct 9;12(19):6413

Background: Subungual exostosis (SE) and subungual osteochondroma (SO) are benign solitary lesions that grow from the distal phalanx. The mass itself is typically painless, but pressure on the nail plate can result in pain and deformity of the involved digit. Tumors can be correctly diagnosed based on clinical, histological and radiographic appearance alone. Surgical resection of SE/SO is typically curative, with a small risk of recurrence.

Methods: The study was retrospective and observational, involving 74 patients with subungual SE/SO. The surgical procedure consisted of the removal of the tumor from the dorsal approach under digital anesthesia. The procedure was assessed using a questionnaire and photo documentation after a minimum of 6 months after surgery.

Results: A total of 85% of respondents were satisfied with the procedure. Nearly 80% of patients rated the cosmetic effect as good or very good. Young age and pain intensity after surgery showed statistically significant associations with worse satisfaction. Age < 18 was associated with recurrence.

Conclusions: Worse satisfaction is strongly associated with recurrence. Gender, duration of symptoms, pain before surgery and tumor size and destruction of the nail plate had no significant effect on recurrence. The technique using burr appeared to be a more effective treatment.
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