photos by Sydney Foot and Ankle Surgeon Damien Lafferty

I see a regular amount of subungual exostosis throughout the year. Typically they have been treated as ingrown toenails (IGTN) first. The GP and the podiatrist may assume it is hypergranulation tissue or some other sign of an IGTN and, in some situations, a PNA may have been carried out (not in this situation).

When the lesion feels firm and it does not respond to an attempt to clear a spicule, it is important an X-ray is taken to assess for an exostosis.

The podiatrist who referred this case did indeed correctly predict the exostosis was present, referred the patient for an X-ray and then on to see me.

Most commonly these lesions are osteochondromas, which are the most common noncancerous bony growths. They are benign lesions with an osseous stem and cartilaginous cap, often looking like a small mushroom.

They are not malignant; however, they will slowly grow and eventually protrude through the skin, producing a portal of entry for bacteria and hence chronic infections.

The surgery is very straightforward and can be done under LA if the patient desires. Recovery is very quick and they rarely return. Once removed, they are always sent for histopathology to ensure nothing more sinister is occurring.

If you have any specific questions or would like to discuss similar cases, feel free to contact me.

(This content is intended for healthcare professionals only)