Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Subungual Exostosis Management

Discussion in 'General Issues and Discussion Forum' started by MelbPod, Oct 16, 2009.

  1. MelbPod

    MelbPod Active Member


    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
     
  2. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Should XR confirm so, yes.

    LL
     
  3. MelbPod

    MelbPod Active Member

    Thanks LL
     
  4. Paul Bowles

    Paul Bowles Well-Known Member

    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!
     
  5. drscouse

    drscouse Member

    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
     
  6. stevewells

    stevewells Active Member

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

Share This Page