Subungual exostosis of the toes in children and adolescents: a clinical experience

BACKGROUND: Subungual exostosis, or bone-cartilaginous overgrowth in the area of toe nail phalanx injures soft tissues, causes painful sensations and impedes the nail plate growth. Most often, subcutaneous exostosis is diagnosed, by mistake, as ingrown toe nail, especially when the pathology is localized in the area of the first toe.

AIM: To evaluate diagnostic and curative outcomes in patients with subungual exostosis of the toe. To identify criteria for the diagnostics of osteochondromas with subungual location in children and adolescents. To define differential diagnostics with other lesions of toe nail phalanges.

METHODS: 14 children and adolescents with osseocartilaginous formations of the subungual plate of the toe (subungual exostosis) were treated at the orthopedic and traumatologic department No 2 in the St. Vladimir Clinical Hospital in Moscow in 2023–2024. Before admission to our hospital, patients were diagnosed with ingrown toe nails and were treated accordingly, including surgical interventions, in other medical settings.

RESULTS: All patients operated in our hospital were diagnosed with “osteochondroma” as a result of histological examination and pathomorphological conclusion. Two-year postoperative follow-up revealed no growth recurrence and other complications, what allowed us to make a number of general comments. In particular, in the case of recurrences of ingrown toenails after surgical treatment, an X-ray of the area of interest should be performed, at least, in two mutually perpendicular projections. Subungual exostosis can be suspected and diagnosis can be verified by X-ray examination of fingers. In order to define a full volume of the formation, computed tomography of the area of interest in the preoperative period was done.

CONCLUSION: The rarity of subungual exostosis is relative―much depends on the doctor’s knowledge and his alertness to this pathology. Radical surgical removal of subungual exostosis is the only correct and effective technique for treating bone and cartilage overgrowth. Only complete removal of the formation prevents the recurrence of the disease.