• Painful inflamed nail sulcus and surrounding tissues
  • Commonly 1st toenails
  • Wound caused by either sharp penetration by the nail plate, or secondary to prolonged pressure and tissue degradation.

Diagnostic Tips

  • Painful and inflamed at distal edge of nail plate
  • May be infected
  • May be complicated by hyperhranulation tissue
  • More common in teenagers
  • Tight footwear will contribute
  • Look for evidence of poor toenail care.

Tests and Imaging

  • Pain on lateral pressure, or direct pressure on nail plate.
  • Wound swab for chronic infection
  • Xray may exclude phalangeal exostosis

Immediate Treatment

  • Advise saline footbath and use of antiseptic
  • Advise open toed footwear
  • Antibiotics may be appropriate
  • Resect toenail

Posssibe referral

  • Podiatrist for resection of nail edge, footwear advice, nailcare advice, possible matrixectomy for recurring problems.
  • Orthopaedic surgeon for removal of exostosis.