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Only the great toes are affected by this, since only the great toe has nail folds at either side of the nail.

The condition is common and amenable to simple treatment but a proportion require removal of the nail, or excision of the outer thirds of the nail and ablation of the nail with phenol.

Antibiotics for flares of paronychia, surgical spirit to dry and toughen the skin, cutting the nail straight so as to leave corners and propping those up with small pledgets of cotton wool, wearing good footwear and going barefoot for some of the time will often be followed by resolution.


Trimming the edge of the nail so it is slightly tapered to the front with suitable instruments and experience is another approach.


Excision of nail, either as a wedge or in its entirety. The nail bed matrix may need to be excised (matricectomy) or destroyed with phenol to prevent regrowth. Evidence in a Cochrane review favours phenol, possibly at the expense of a higher rate of infection.[1]

Avulsion of the nail may be better performed by opening a small haemostat under the nail to detach it rather than just pulling.


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