Probably one of the most frequently miss-diagnosed conditions in our sphere of medicine!
This chap was referred to our office for treatment of his fungal nail as it had been unresponsive to previous treatments. He has been extremely active throughout his 60+ years of life so far. The last year and a half his various seasonal activities have interrupted by pain in his right toe becoming progressively worse. Despite several visits to specialists and various diagnoses and subsequent treatments the pain finally got so bad he backed out of his annual ski trip with buddies, this year to Austria. The ski boot just is unbearable when in contact with his toe.
WELL, OF COURSE, ITS UNBEARABLE!!!!!!
Seriously, no one thought to debride the nail plate or reduce its bulk a little. Nope, another expensive hi-tech course of treatment for fungal nails. Fortunately, he is in enviable good health, combine this presentation with peripheral vascular disease, neuropathy, or diabetes…….. and we could have been looking a life-threatening situation.
Ok so what is it you ask?. Well with a brief investigation into his history, we discovered that a fast-moving hockey puck damaged his nail many years ago causing some bruising and subsequently the nail was always a little thicker and slightly discoloured. The thickening resulted in a mild increase in pressure on the nail plate from the upper of shoe. Naturally his nail responded to the pressure by becoming even thicker and as a result more pigmented. Eventually it became harder and harder to trim, finally pressing against the end of the shoe and redirecting its growth finally down wards and then into the flesh as the pictures demonstrate. The name given to this nail formation is “Rams horn nail”, given the similarity to the formation of the horn on the head of a male goat. In humans they are non gender specific 😉
Relief is instant and painless, a matter of a few minutes work. The nail plate once damaged like this will always continue to grow thicker and will require occasional management to prevent recurrence of the discomfort. Removal of such a nail to attempt normal regrowth is futile and disappointing at best, but with regular care it can be painless and unobtrusive.
Good news! flights confirmed, boots feel great and Austria is back on again. Thanks to all the lovely patients that Thursday.
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