Onychophosis

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Onychophosis/onycoclavus

Hyperkeratosis and/or helomata in nail sulcus – may be exacerbated by cellular and other debris in nail groove.
Heloma is more common under distal edge of nail plate
Ranges from asymptomatic to extremely painful.
Not always obvious (and is often missed) – but generally has a distinct hyperkeratosis appearance.
In severe cases the periungual tissues will be inflamed.

Due to lateral pressure from tight footwear or adjacent toe; poor nail cutting technique, leaving rough edges; subungual exostosis.

Differential diagnosis – melanocytic lesions; epidermoid cyst; foreign body; subungual exostosis

Treatment – debridement with ‘Blacks’ file and scalpel; some advocate soaking with hydrogen peroxide prior to debridement to soften tissues; keratolytics may be used in nail sulcus; footwear advice; padding to reduce pressure from adjacent toe.

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