Common Toenail Injuries in Athletes
Subungual Exostosis is a benign osteocartilagenous tumor that occurs under toenails, most commonly the great toe. Although poorly understood, it is associated with repetitive microtrauma and can be seen in athletes. Exam will reveal a firm, fixed nodule with a hyperkeratotic smooth surface at the distal end of the nail plate. Radiographs will show a pedunculated radiopaque mass on the dorsomedial surface of the distal phalanx. Most cases are managed with surgical excision and athletes can return to play fairly quickly. Recurrence rate is about 4%, post-surgical deformity is about 16%.
Image 5. Example of a nailbed laceration repair. Note the physician sutured the original nail plate back in place after.Mignemi, Megan E., Kenneth P. Unruh, and Donald H. Lee. “Controversies in the treatment of nail bed injuries.” Journal of Hand Surgery 38.7 (2013): 1427-1430.
Paronychia is inflammation, often infectious in origin, of the lateral and proximal nail folds. It can be acute (<6 weeks) or chronic (>6 weeks) and is more common in fingers than toes. Acute injuries are associated with tight fitting shoes and trauma while chronic paronychia are often the result of occupation related chemical irritants. In acute paronychias, patients report rapid onset of pain, swelling of the nail fold. On exam there may be erythema and edema and an abscess is often present. Management of acute paronychia includes topical antibiotics, topical burow’s solution or acetic acid, topical steroids and in severe cases, oral antibiotics. If an abscess is present it should be drained. Chronic paraonychia primarily involves discontinuing the offending activity, but may also involve topical therapies.
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|↑3||Case courtesy of Dr Ayush Goel, Radiopaedia.org, rID: 74749|
|↑4||Mignemi, Megan E., Kenneth P. Unruh, and Donald H. Lee. “Controversies in the treatment of nail bed injuries.” Journal of Hand Surgery 38.7 (2013): 1427-1430.|
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