05/06/2026
When an “ingrown toenail” is not actually an ingrown toenail
Signs it may be more than an ingrown nail:
· Recurrent ingrown toenails affecting the same border despite treatment
· Elevation, distortion, or lifting of the nail plate
· Granulation tissue that persists or rapidly recurs
· Unilateral nail changes affecting a single toe only
· Tenderness directly under the nail
Diagnosis requires:
· X-ray imaging to confirm the presence of a bony outgrowth from the toe
· Clinical examination
What is a subungual exostosis?
A subungual exostosis is a benign bony growth that develops beneath the nail bed, typically because of irritation or trauma triggering abnormal localised bone formation. Although the exact cause is not always known, it is most associated with repetitive mechanical stress, acute injury, or chronic infection and inflammation.
Definitive treatment is usually:
• Surgical excision of the exostosis
• Removal of the bony prominence down to healthy bone to reduce recurrence risk
• Preservation of the nail bed, where possible, to minimise nail deformity
Treatment may involve surgical removal of the bony prominence to relieve pain and prevent recurrence. This can be done under local anaesthetic.
If you have a toenail issue that just isn’t improving, it may be worth getting it properly assessed.