Subungual Exotosis: A Bone Spur Under the Toenail

Robert G. Parker
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Dr. Parker is a podiatrist and surgeon in Houston, TX who has been helping patients for more than 40 years.

Your toenails are susceptible to a number of strange and unusual conditions. Subungual exotosis is one of these. It is basically just a fancy way to say that there is a bone spur under the toenail. There are other types of bone tumors that can be found under and around the toenails as well, and it is important to know what type you are dealing with.

What is a Subungual Exotosis?

A subungual exotosis is an unnatural bony prominence, which grows under the nail. It is typically a result of a trauma to the nail, but can also be caused by chronic irritation. It will often disturb the nail plate (like a tree root bringing up the sidewalk), and it can cause pain and discomfort. The first sign of a subungual exotosis is a deformity of the nail, followed by a small isolated mass beginning to protrude from the nail plate. They can also be found on your fingernails, but are more commonly seen on the feet.

Treatment Options

One-stitch, minimal incision technique used by Dr. Parker for treatment of subungual exotosis in Houston, TX.The most preferred treatment option with subungual exotosis is surgical removal. There are three different types of surgery that can be used depending on the severity of the growth. The first is either the partial or complete removal of the nail. The second is the removal of just the bone spur. The third is a different type of removal where instead of cutting off the tumor the doctor will scrape it off using a small tool called a hand rasp. Since surgery is the only treatment option for this condition, it is very important to make sure you are following all post-operative instructions very carefully to avoid complications and infection. This means keeping the surgical site clean and dry and changing your dressings daily. There is a possibility of recurrence with subungual exotosis.

Other Types of Benign Bone Tumors

Subungual exotosis is not the only type of benign bone tumor found on and around your nails. There are two others as well:

Osteochondromas are very commonly found in adolescents and young adults. They can cause deformity to the nail and they are linked to ingrown toenails as well. Unlike subungual exotosis they are generally painless. The only way they might cause discomfort is if they cause irritation to the surrounding tissues. In most cases the absence of pain will prevent your doctor from wanting to remove the tumor surgically. Careful monitoring to make sure nothing changes is the only treatment you will need. However, if it begins to cause you pain and makes doing daily activities difficult, you might be looking at surgical removal of the growth.

Enchondromas are also common in younger people. They are found in the small bones of the hands and feet. They are usually benign, but may become cancerous. There is typically no pain associated with this type of tumor, but if you feel discomfort at night it may have become malignant. A simple X-ray or CT scan can show whether the growth is benign or malignant. If it causes no pain, treatment is usually not needed. When surgery is needed it is usually a simple procedure of scraping out the tumor and refilling it with a bone graft.

When to Call Your Doctor

If you are suffering from bone spur under your toenail, you should be under a doctor’s care, especially if pain is involved. Call Dr. Robert Parker at (281) 497-2850 to schedule an appointment at Parker Foot and Ankle in Houston.