Toe / Digital Deformities


The most common toenail problem is an ingrowing toenail. In growing toenails, can occur through several reasons to include an increase in the curvature of the nail and injury e.g. dropping an object onto the toe or picking the nail so that it pulls away into the sides of the toe. Other causes include a bony prominence arising from the bone beneath the toenail.

The prominent bone causes the nail to curve and dig into the sides of the nail producing an ingrowing toenail. Often an exostosis of the toe is diagnosed after recurrent ingrowing toenails despite nail avulsion procedures.

Management of these conditions vary depending on the cause of the problem. An in growing toenail without an underlying bone growth can be managed through a partial nail avulsion. This involves a local anaesthetic to each side of the toe, once the toe is numb the offending section of nail is removed and a chemical applied to prevent the nail from growing back.
In the case of a subungual exostosis it involves removal of the underlying prominent bone. Over time this should produce relaxation of the surrounding tissue and nail and allow for a resolution of the problem.

In the case of thickened toenails that have been unresponsive to routine podiatric care a total nail avulsion may be indicated. This is the same procedure as a partial nail avulsion but involves removal of the whole nail followed by the application of the chemical that prevents the nail from growing back.

toe nail problems

Subungual exostosis on the inside of the big toe bone of a young patient (growth plates are still open)