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. 2020 Aug 30:58:160-166.
doi: 10.1016/j.amsu.2020.08.025. eCollection 2020 Oct.

Efficacy of a tip of the big toe remodeling in the distal nail embedding with bone overgrowth of the distal phalanx

Mikołaj Dąbrowski  1   2 , Anna Litowińska  2 , Jolanta Cieślak  2
Affiliations

Efficacy of a tip of the big toe remodeling in the distal nail embedding with bone overgrowth of the distal phalanx

Mikołaj Dąbrowski et al. Ann Med Surg (Lond). .

Abstract

Introduction: Distal nail embedding due to hyponychium hypertrophy can be caused by traumatic or surgical avulsion of the nail. As a consequence of these changes, the nail plate is blocked through the deformed tip of the toe. Changes that occur at the tip of the big toe are due to bone growth on the dorsal surface of the distal end of the distal phalanx. This study aimed to present a surgical technique for the treatment of hypertrophy of the tip of the toe and evaluate its effectiveness.

Material and methods: The surgical technique involved remodeling of the tip of the big toe, with removal of the hypertrophied bone of the distal phalanx. The procedure was assessed by using a questionnaire.

Results: We included the 108 distal embedded nails. A total of 85% of respondents were satisfied with the procedure. Nearly 80% of patients rated the cosmetic effect as good or very good.

Conclusions: The technique was an effective treatment and increased the quality of life of those with disorders of nail growth associated with hypertrophy of the tip and hyponychium, with bone overgrowth.

Keywords: Deformity of hyponychium; Distal nail embedding; Osteophyte of distal phalanx; Surgical technique.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Changes in the toenail due to distal nail embedding with bone spur: lack of growth of the nail plate, chromonychia (discoloration), onychatrophia (deformity, crushing and atrophy), onychomadesis (shedding of the plate from the matrix side), onycholysis, and deformation of the tip of the toe.
Fig. 2
Fig. 2
Lateral X-ray image of a bone spur of a distal phalanx with a nail growth problem.
Fig. 3
Fig. 3
Ultrasound imaging of a bone spur of a distal phalanx with a nail growth problem.
Fig. 4
Fig. 4
An intraoperative image of a bone overgrowth from the distal phalanx.
Fig. 5
Fig. 5
The surgery technique.
Fig. 6
Fig. 6
Percentage of answers to questions about patients' satisfaction with surgical treatment Legend: 1 = “strongly disagree” and 7 = “strongly agree”.
Fig. 7
Fig. 7
Postoperative responses of patients who underwent surgical bone spur removal. Graph of the mean values and standard deviations of the answers to questions about satisfaction with the surgery.
Fig. 8
Fig. 8
Clinical outcomes of treatment before and after surgery.
Fig. 9
Fig. 9
Subnail hematoma after embedded distal nail surgery.
Fig. 10
Fig. 10
Hematoma at the treatment site and prolonged healing.
Fig. 11
Fig. 11
Probable sequence of changes leading to the formation of a bone outgrowth.
See this image and copyright information in PMC

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