Subungual Exostosis Removal - A Minor Surgical Procedure

Introduction

A subungual exostosis is a peculiar condition characterized by the development of a bony growth beneath the nail. This unique anomaly can be a source of persistent pain and discomfort while presenting functional and cosmetic concerns for those affected. In this article, we will comprehensively explore the underlying causes, common symptoms, methods of diagnosis, and the management strategies employed in addressing subungual exostosis.

What Is Subungual Exostosis?

Subungual exostosis, a bony outgrowth beneath the nail, constitutes a painful ailment with roots dating back to its initial description by Dupuytren in 1817. This condition frequently necessitates surgical intervention, as it manifests as a benign tumor originating from both cartilage and bone, typically presenting as a painful lump beneath the nail plate.

What Are the Causes of Subungual Exostosis?

While the precise origins remain somewhat enigmatic, subungual exostosis emerges from a complex interplay of factors, with causes varying among individuals. Key contributors to its development encompass:

• Genetic Factors: Certain individuals harbor a genetic predisposition to forming bony growths beneath their nails, rendering them more susceptible to this condition's emergence.

• Trauma: Repetitive nail injuries or persistent trauma can serve as catalysts for developing these bony protrusions beneath the nail bed.

• Chronic Irritation: Prolonged inflammation of the nail matrix, often spurred by factors such as fungal infections or ingrown toenails, can incubate conditions conducive to subungual exostosis.

• Hormonal Factors: Fluctuations in hormonal balance at times can be linked to the onset of this condition, introducing another layer of complexity to its etiology.

• Inherited Conditions: Certain hereditary syndromes, such as multiple exostoses-mental retardation syndrome and multiple exostoses syndrome (a rare genetic anomaly marked by skeletal irregularities, intellectual challenges, and facial characteristics), can heighten susceptibility to the development of subungual exostosis, emphasizing the multifaceted nature of its origins.

What Are the Features of Subungual Exostosis?

Clinical presentations of subungual exostosis exhibit variability in severity, with a predilection for the great toe, predominantly afflicting younger individuals, often around the age of 20, with a higher incidence in females. Notable characteristics include:

• Pain: The most prevalent symptom arises from the bony growth's unwelcome pressure upon the delicate area beneath the nail, yielding sharp, persistent pain. This discomfort can intrude upon daily activities like donning shoes or walking.

• Discoloration: The nail above the bony outgrowth may undergo chromatic transformations, manifesting hues of yellow, brown, or even inky black.

• Swelling: Localized swelling, coupled with inflammation, may encircle the affected nail, contributing to discomfort.

• Change in Nail Shape: As the bone continues its gradual growth, the nail's form undergoes distortion or elevation, occasionally sparking cosmetic concerns.

• Sensitivity to Pressure: Heightened sensitivity emerges when even gentle pressure is applied, resulting from nerve endings compressing under the condition's influence.

• Visible Bony Growth: A palpable lump beneath the nail may become apparent in advanced stages, though this feature typically manifests only in later phases.

• Nail Lifting: The affected nail may experience separation or elevation due to the ongoing growth of bone and cartilage beneath.

How Is Subungual Exostosis Diagnosed?

Diagnosing subungual exostosis involves a multifaceted approach:

• Clinical Examination: Typically conducted by a dermatologist or orthopedic surgeon, this examination meticulously assesses signs and symptoms, delving into the subtleties of the condition.

• Medical History: Thorough inquiry into past injuries or trauma to the affected area is crucial. Genetic factors also play a role, so inquiring about a family history of this condition is essential.

• Imaging Studies: Employing X-rays for a comprehensive evaluation offers invaluable insights into the condition's severity, extent, size, and impact on neighboring tissues.

How Is Subungual Exostosis Removed?

A subungual exostosis is typically surgically removed to relieve pain and restore the nail's normal appearance. Here's a step-by-step guide to the procedure:

• Preoperative Assessment: Before surgery, a comprehensive assessment includes a medical history review, clinical examination, and imaging studies such as X-rays.

• Anesthesia: Local anesthesia, often in the form of a digit block, is commonly administered, making general anesthesia unnecessary.

• Nail Incision: An incision is carefully made in the nail region to access the bony growth. This incision can be made at the side or base of the nail, depending on the case.

• Removal of Exostosis: Specialized instruments are employed to extract the bony growth, and a curette is used to remove any remaining bony tissue to prevent recurrence meticulously.

• Nail Repair: Following the removal of the bony growth, nail repair may be necessary. This can involve suturing the nail bed or removing a small portion of the nail to ensure proper healing.

• Dressing: A sterile dressing safeguards the surgically treated area after the bony growth and nail repair are completed.

• Postoperative Care: The postoperative care regimen involves maintaining the area clean and dry. Healthcare providers should monitor the surgical site, and any sutures or dressings should be addressed during follow-up appointments.

Are There Any Tips to Prevent Subungual Exostosis?

Some tips to help prevent subungual exostosis are:

• Proper Footwear: It is crucial to wear shoes that fit correctly. Ill-fitting shoes can exert unnecessary pressure on the toes, increasing the risk of developing subungual exostosis.

• Proper Nail Care: Pay attention to the toenails. Ingrown toenails, which can occur when the nail grows into the surrounding skin, can contribute to the developing of this condition.

• Hygiene: Maintaining good hygiene is essential. Keep nails dry and clean to prevent infections, as chronic infections can increase the risk of subungual exostosis. Regularly cleaning and drying the feet and nails is important.

• Avoid Trauma: Be cautious to avoid accidental injuries or repeated trauma to the toes. Protect the toes by wearing appropriate footwear, especially when there is a risk of injury.

• Protective Gear: If one participates in activities that involve running or kicking, such as sports, consider using protective padding or gear to shield one's toes from potential trauma.

By following these general measures, one can reduce the risk of developing subungual exostosis and maintain the health of the toenails and toes.

Conclusion

Surgically removing a Subungual Exostosis offers a promising outlook. This procedure not only alleviates pain but also revives nail function. Taking action early can significantly reduce its impact on one’s life.