Retronychia is a painful nail condition. It occurs when the nail plate grows backward into the proximal nail fold, causing discomfort. This article explains retronychia, its diagnosis, and treatment options to alleviate symptoms and restore nail health.
What is Retronychia
Retronychia is a nail disorder where the nail plate, the visible part of the nail, embeds itself into the proximal nail fold, the skin at the base of the nail. Instead of growing forward, new nail growth pushes the existing nail plate upwards and backward. This unusual growth pattern results in the characteristic stacking of multiple nail plates beneath the proximal nail fold.
Individuals with retronychia experience symptoms, including pain, inflammation, and swelling around the affected nail. The nail plate may appear discolored, often yellowish or white, and a sign is the absence of a visible cuticle. This condition most commonly affects the great toenails, though it can occur in other digits.
The causes of retronychia are linked to trauma. Repetitive microtrauma, such as from ill-fitting shoes or sports activities like running or dancing, can disrupt normal nail growth. Acute trauma, like a direct impact to the toe, can also initiate the condition. Systemic conditions or severe stress can also contribute.
Diagnosis of Retronychia
Diagnosing retronychia involves clinical examination by a healthcare professional, such as a dermatologist or podiatrist. They observe characteristic signs, including inflammation and swelling of the proximal nail fold, discoloration of the nail plate, and the absence of the cuticle. The presence of stacked nail plates, even if not immediately visible, is an indicator.
Patient history plays a role in diagnosis, with information regarding recent trauma or footwear being relevant. This helps differentiate retronychia from other nail conditions with similar symptoms. Diagnosis can be challenging because not all symptoms may be present, and it can be mistaken for issues like chronic paronychia or fungal infections.
High-resolution ultrasound imaging is a non-invasive tool to confirm the diagnosis. This technique allows visualization of stacked nail plates and helps rule out other potential causes. Ultrasound shows the multiple layers of nail plates and any associated inflammation around the nail matrix.
Treatment Approaches for Retronychia
Initial treatment often involves conservative, non-surgical methods, more effective for acute cases or palliative care. Avoiding causative factors, such as wearing properly fitting shoes with adequate toe room, is a first step. This helps reduce repetitive pressure on the nail, which can exacerbate the condition.
Topical or oral anti-inflammatory medications may be prescribed to reduce pain and swelling. Sometimes, corticosteroid injections into the nail fold can decrease localized inflammation and discomfort. Nail softening agents may also be considered to make the nail more pliable, easing pressure. These conservative measures provide temporary relief but rarely a permanent solution for chronic retronychia.
For chronic or recurrent retronychia, surgical intervention is the most definitive treatment. One common procedure is partial or complete nail avulsion, which involves removing part or all of the affected nail plate. This relieves pressure from stacked nail plates and allows for new, healthy nail growth.
In cases of persistent recurrence, a matrixectomy may be performed. This procedure permanently removes or destroys the nail matrix, the tissue responsible for producing the nail plate, to prevent future nail growth. Matrixectomies can be performed chemically or through surgical excision. These procedures should be carried out by a qualified medical professional to ensure proper technique and minimize complications.
Post-Treatment Considerations
After treatment, recovery varies depending on the intervention. Non-surgical approaches have minimal downtime, while surgical procedures require a longer healing phase. Patients undergoing surgery can expect discomfort, and proper wound care, including regular cleaning and dressing changes, prevents infection.
Pain management strategies are provided by the physician, which may include over-the-counter pain relievers or prescription medication. Following all post-operative instructions diligently ensures smoother recovery and reduces complications. New nail growth following avulsion can take several months to over a year to appear.
Recurrence is possible, especially if underlying causes like chronic trauma from ill-fitting footwear are not addressed. If a matrixectomy was not performed, the condition may return, especially if the nail matrix was not fully corrected. Regular follow-up appointments with the physician monitor healing and address concerns. Continued proper nail care and informed footwear choices are important steps in preventing future issues.