Information
A subungual exostosis is a small extra growth of bone which arises from the bone at the end of the toe. Usually this is the big toe but sometimes it involves the smaller toes. The pain can be made worse with shoes and can prevent participation in sporting activities.
The growth of bone is completely benign.
We are not sure what causes the extra bone to form but usually it affects young adults. Trauma (injury to the toe) is often said to cause these swellings but we have no proof that this is actually the case. Very occasionally it affects older people.
The diagnosis is confirmed with an x-ray.
The treatment involves a small operation to excise the extra growth of bone.
The procedure
With excision of a subungual exostosis operation, first of all the toenail is cut back or sometimes the toenail is removed completely. Then an incision is made over the bony swelling and the swelling is removed from the underlying bone. Usually the specimen is then sent to the pathology lab to confirm the diagnosis. Then, the skin incision is either stitched closed or left to heal from the base. The toe is covered with a dressing and a bandage and you will be given a sandal to wear home.
Who can refer:
GPs
Who to refer:
- Patients with known subungual exostosis who are symptomatic
Who not to refer:
- Cosmetic reasons
- H/o Peripheral arterial disease
- Patients who do not want to consider surgery.
How to refer:
SCI gateway (Lauriston Buildings > Orthopaedics – Foot and Ankle)
Minimal Referral Details:
- X-rays
- Length of time since symptoms started
Subungual Exostosis Excision: https://edinburghorthopaedics.org/media/p1bbqs3c/subungual-exostosis-excision-v2-0.pdf
