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A 68 yro male with clean medical history, not on any medication has been referred by local GP for sore "ingrown toenail".
Patient noticed swollen spot on tibial side of L hallux for about 6 months. Not really sore except for one spot (distal medial end). No trouble in feet before and no direct trauma. The lesion itself is completely away from the nail edge. In fact, there was no ingrowing of the nail at all, the nail was not involuted nor had any spike left in the sulcus. There was no hard skin or corns in the sulcus.
There was also no trauma or cut to the skin.
No bite marks or redness, nor inflammation were observed.
Patient also don't wear tight shoes (have checked shoes today, very roomy - wear these shoes most of the time).
I tried drawing it out with 5mL syringe but got nothing out of it.
Checked the nail edge thoroughly with nail file - nothing.
Completely stunned as what it could be as it's definitely not ingrown toenail.
My gut feeling is that it's some sort of cyst.
I have referred patient for ultrasound but don't think it'll find anything conclusive, then I'll truly be clueless.
So if you got any idea what it could be, would really appreciate your opinion.
As LL says, an image would be a great help. Do not overlook the possibility of sub-ungual exostosis with a soft tissue cap, and bear in mind the possibility of a non-pigmented melanoma. The U/S should be helpful.
Mucoid cyst should be on the top of your differential diagnosis list. Photo would be helpful. Also transilluminate the mass w a penlight. It should be translucent if a mucoid cyst. Excision should include a rotation flap as they have a high recurrence rate. Also take down underlying bony prominence if present.
The Following User Says Thank You to Graziano For This Useful Post:
Any one of those; also plastics. However, you may find that none of them is terribly interested, until, that is, you mention the words 'podiatric surgeon' when you will have orthopods crawling out of the woodwork 19 to the dozen claiming that you are infringing their territory. Of course, you may have utterly charming and helpful orthopods in NZ who are nothing like their tribal UK species.
All the best
PS If the patient has good private insurance they'll all fall over themselves!