Summary
- 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.
