RETRONYCHIA

By Gary M. White, MD

Retronychia Individuals with the 2nd toe longer than the 1st (Morton's foot or Greek foot) may have it preferential affected by retronychia.


In retronychia, the nail plate is driven into the proximal nail fold causing pain, erythema and inflammation. Multiple nail plates may form, one on top of the other and a chronic paronychia is typical. Onycholysis is a common component and probably adds to the weakness of the nail structure, allowing trauma to better manipulate the nail. Both children and adults may be affected. The great toe is most commonly affected, but in individuals with a long 2nd toe, it may be affected preferentially, as illustrated above.

Clinical

The proximal nail fold is swollen and inflamed. Granulation tissue may be seen. Patients may complain of pain and impaired walking. The patients should be questioned about trauma, sports, dancing, and tight or uncomfortable shoes. Reported causes include tight-fitting shoes, hiking, jogging, dancing and osteoarthritis.

Treatment

Conservative therapy may be tried initially with an oral antibiotic and a potent topical steroid. Shoe wear should be assessed and any tight-fitting shoes eliminated. Physical activities that may contribute should be addressed [JAAD 2015:73:849].

Taping may be curative in early cases as it: provides added strength to the nail apparatus, fixes the nail to the nail bed, prevents retrograde movement against the proximal nail fold, and allows the nail to grow distally [JEADV 2016;30;16]. Otherwise, nail avulsion has been recommended as the treatment of choice, but permanent nail dystrophy may occur.

References

Dermatology Online Journal 18 (6): 9

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