Nail Disorders

Involution – Pain and tenderness to the sides of the toe nail as well as the tip of the toe. Nail curvature is exaggerated and can look C shaped when viewing from the apex. This can often be confused with an ingrowing nail. Can often be managed with good personal foot care. 

Onychocryptosis (Ingrowing Nail) An ingrowing toenail is where a piece of nail pierces the flesh of the toe. It can be extremely painful and inflamed or infected.
Ingrowing toenails most commonly affect the big toenail, but can affect the other toes too. A nail that is curling (involuted) into the flesh, but is not actually piercing the skin, is not an ingrowing toenail but can be very painful and can also appear red and inflamed.

image courtesy of NHS Lothian

Thickened and overgrown nails – Often characterised with thickening of the nail plate as well as discolouration. This is caused by a prolonged period where no personal foot care has been attempted. Often these are successfully self managed once the length and thickness has been addressed on a one off basis. Can often be prevented by good personal foot care. 

Paronychia and Retronychia – Paronychia: Pain and tenderness to the toe at all sides of the toenail and on top of the toenail. Surrounding skin can be red and inflamed. In some cases this can become infected. Retronychia is linked with recurring paronychia. The nail will split close to the cuticle and ingrow into the nail fold. Usually a split is noted and/or redness at the cuticle and/or exudate.

​Subungal Exostosis – A subungual exostosis is an isolated slow‐growing benign osteochondral outgrowth from the distal phalanx, which arises from under the nail. The big toenail is affected in three-quarters of cases. Less commonly, it affects other toes, or the fingers. A firm nodule develops from beneath the nail bed. The nodule usually grows slowly over weeks to months, and develops a thick hyperkeratotic surface. As it enlarges the nodule causes the nail plate to separate from the bed 

Subungal Haematoma Deep red/black discoloration under the toe nail plate often following a trauma. In acute phase can be very tender to touch with inflammation of the surrounding skin seen. Once the acute phase has passed then often there is no pain. There is a clear demarcation line were new healthy nail grows. It can take up to 1yr for a new healthy nail to regrow. No management required. 

Subungal Ulceration – This can be painful however often they are asymptomatic particularly in those with altered protective sensation. A break in the skin occurs under the nail plate. Often a soft, spongy layer is noted and discharge is evident. There may be some swelling of the surrounding skin particularly if the site is infected.