Onychophosis (onychoclavus) is the presence of a hyperkeratosis (callus) and/or helomata (corn) in the nail sulcus. It may be exacerbated by the collection of cellular and other debris in the nail groove. A heloma is more common under distal edge of nail plate rather than down the sulcus. It can range from asymptomatic to extremely painful. The hallux nail folds are the most commonly affected.
Onychophosis is not always obvious and is often missed. It does generally have a distinct hyperkeratosis appearance. In the more severe cases, the periungual tissues can be inflamed.
The main causes of onychophosis is due an involuted or curve to the nail so the edge puts more pressure on the nail sulcus; increased lateral pressure on the nail sulcus from tight footwear or adjacent toe, especially in those with hallux valgus; poor nail cutting technique, leaving rough edges after cutting the nail.
Differential diagnosis – onychocryptosis; melanocytic lesions; epidermoid cyst; foreign body; subungual exostosis.
Onychophosis is frequently confused with an ingrown toenail (onychocryptosis).
Onychophosis Treatment:
Skillful debridement with a ‘Blacks’ file and scalpel along with a reduction in the thickness of the nail (video). The nail sulcus may be packed with a small amount of cotton wool after debridement if it is tender to keep the nail away from the area. A maintenance program with regular care may need to be set up for this over the longer term.
Some advocate soaking the nail sulcus with hydrogen peroxide prior to debridement to soften the tissues; others prefer to not use that.
Keratolytics may be used in nail sulcus.
Urea-based emollients may be helpful to prevent a recurrence.
Footwear advice to reduce pressure on the toe.
Interdigital padding with felt or a silicone orthodigital device may be used to reduce pressure from the adjacent toe.
Surgical: partial nail removal should be considered.
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