Subungual exostosis and chronic onychocryptosis: An intricate relationship - clinical review and management

Abstract

Subungual exostosis (SE) is a relatively common benign bone tumor occurring primarily in the distal phalanx of the toes, particularly the hallux. Nail deformities, such as onychocryptosis / paronychia, can present concurrently, leading to complex clinical scenarios. Although SE and onychocryptosis are separate conditions, their clinical presentations can sometimes overlap, mainly when SE occurs under the nail bed, leading to nail deformation and subsequent ingrowth. When an ingrown toenail accompanies SE, the situation can become more complex due to increased pain and risk of infection. Diagnosis in these cases requires careful clinical examination and imaging studies. Any surgical intervention for the SE should consider concurrent pathological nail growth and nail bed abnormalities. The ultimate treatment goal is restoring normal anatomy, including salvage of the nail plate.Given these conditions' potential overlap and shared symptomatology, clinical vigilance is essential for appropriate diagnosis and treatment.This paper reviews the interplay between these conditions, their combined impact on patient morbidity, and effective surgical management strategies.