Curvature of the nail plate - causes, symptoms, diagnosis and treatment

Exostosis of the finger is a rare and not serious disease, but it can significantly reduce the quality of life of patients. Neoplasms of this kind are rarely found on the hands; more often they form in the feet, especially on the big toe. By exostosis we mean an osteochondral growth on the surface of the phalanx bone in the form of a linear, spherical or comb-shaped formation. It can form on any part of the bone, including under the nail plate. In the latter case, they speak of the presence of subungual exostosis.

Reasons for development

Exostoses of the fingers and toes may represent an osteochondroma, i.e., a benign tumor, or be a consequence of injury, chronic inflammation, or even prolonged wearing of tight shoes. The latter factors more often provoke the formation of exostoses in adults.

Osteochondromas are mainly typical for children and adolescents under 20 years of age. They can be single or solitary, as well as multiple. Solitary osteochondromas of the fingers and toes are a rare occurrence. More often, in the presence of exostoses with such localization, similar lesions of other skeletal bones are found, in particular the femur, tibia, humerus, spine, clavicle, etc.

The reasons for the formation of osteochondromas have not yet been fully established. It is believed that isolated neoplasms of this kind are a consequence of displacement of the epiphyseal plate. This may be due to disorders of embryonic development, radiation therapy at an early age, or exposure to other types of ionizing radiation. Epiphyseal plates are areas of bone growth that are made up of cartilage and are located directly under the “head” of the bone. Due to the fact that its cells are in the process of constant mitotic division, the child’s bones lengthen as they grow older. Subsequently, the cartilage cells located furthest from the epiphyseal plate ossify and form bone tissue.

If, due to the action of one factor or another, a fragment of the epiphyseal plate moves to the side, it continues to synthesize new cells, which also gradually ossify. This is how exostosis forms in children. Initially, it is represented only by cartilaginous tissue, but over the years it becomes dense and hard, but the cartilaginous cap remains. It usually grows in proportion to the rate of bone growth, and therefore is usually detected during puberty, when a sharp growth spurt occurs.

Multiple exostosis disease is considered to be a hereditary disease. Massive skeletal damage by exostoses is usually detected in early childhood and requires dynamic monitoring, since with it the likelihood of malignancy of neoplasms increases. Single exostoses become malignant in less than 1% of cases.

Signs

Very often people do not know how to distinguish an ordinary bruise from a marginal fracture. To do this, you need to familiarize yourself with the important signs of finger damage. They can be roughly divided into:

• relative;
• absolute.

Relative

Symptoms, which are called relative, appear:

• the presence of edema;
• painful manifestations;
• development of hemorrhage under the skin and nail plate.

Absolute

In the presence of absolute symptoms, a fracture is highly likely to be suspected. These include:

• crunching of bone fragments during pressure;
• unnatural position of the phalanx of the finger.

How severe the symptoms will be depends on where the fracture is located.

When the big toe is injured, the symptoms of the fracture are more pronounced and more intense. If the fracture is on the second, third, fourth finger or little finger, its manifestations are not immediately noticeable. For this reason, patients are not in a hurry to see a doctor to receive first aid.

Symptoms

In some cases, exostosis of the toe or hand is asymptomatic. If it forms on the side of the finger, it can cause manifestations of soft tissue hyperkeratosis. But since their volume is relatively small, a full-fledged callus is not formed. If you remove areas of thickened skin, the discomfort does not go away, and the tissues soon become keratinized again.

When exostosis reaches a large size, it injures soft tissues and provokes inflammatory processes in the joints. This leads to discomfort or even pain, especially when wearing tight shoes. It can also protrude beyond the physiological boundaries of the finger. When palpated, exostosis is a dense bony protrusion with a smooth or rough surface. This further aggravates the discomfort.

With active growth of the tumor, the phalanx may become deformed, as well as neighboring fingers. This already leads to the development of an aesthetic defect.

At a certain location, exostosis can compress the neurovascular bundle. The consequence of this is local swelling of the finger, a feeling of numbness or goosebumps.

The most common condition is exostosis of the big toe. This may be accompanied by valgus deformation of this finger, which is manifested by its deviation from the normal axis towards neighboring fingers. As a result, 2-3 toes may also become deformed, acquiring a hammer-like shape.

With subungual exostosis, there is a protrusion at the end of the phalanx of the finger, which looks like a thickened subungual ridge. In this case it is observed:

• pain when pressing on the nail, fingertip, or during physical activity;
• impaired nail growth, up to ingrowth or peeling;
• redness of soft tissues;
• callus formation.

How to diagnose a broken finger

• Upon palpation, the pain sharply intensifies and does not go away for a long time (an hour or two).
• When a fracture occurs, a sharp pain is felt, which can radiate to the nearest parts of the foot. Deformation of the phalanx, unnatural position of the finger. Swelling and strong (acute) pulsation at the fracture site.
• If there is a fracture, the victim cannot move the injured finger. Any attempt to stand on the affected leg causes the patient to experience severe pain. To relieve pain symptoms, the affected finger is fixed in one position.
• Hemorrhages form under the nail, hematoma and swelling appear, and the skin becomes bluish.

Diagnostics

The appearance of signs of exostosis requires contacting an orthopedist-traumatologist. At the appointment, the doctor carefully examines the finger, palpates the growth and finds out the nature of the symptoms. If a dense bone formation is detected, an x-ray is indicated.

With its help, you can not only diagnose exostosis of the toe, but also evaluate its location and size. The images also provide data on the degree of deformation of the distal phalanges and allow you to plan the most effective course of treatment. In rare cases, CT and MRI are additionally prescribed.

First aid

What to do if your thumb is broken? The answer is simple: do not panic and call an ambulance. Before doctors arrive, all efforts should be aimed at anesthetizing the injury site, fixing the limb, and stopping bleeding in an open wound. In order for assistance to be provided effectively, it is recommended to adhere to the following rules:

• Be sure to call a doctor! Despite the absence of pronounced symptoms, you should not refuse to consult a doctor. An experienced specialist will examine the leg, provide pain relief if necessary, and determine whether hospitalization is necessary;
• limb fixation. It is recommended to place the foot on the heel, slightly bending the ankle joint. The thumb should not touch surrounding objects. In this position the pain decreases;
• immobilization is performed only when displaced. It has now been proven that non-displaced fractures do not need to be fixed with available means before the ambulance arrives. Attempts to change the position of the finger or straighten it lead to increased pain and worsening of the condition;
• pain relief is an integral part of treatment. You can relieve pain with ibuprofen, analgin, nimesil;
• Cold is your best friend when you have a thumb injury. As a result, swelling decreases due to vasoconstriction, and pain becomes less pronounced.

Note! To prevent frostbite, apply an ice pack for a maximum of 10 minutes. Next, you should take a break of 3-4 minutes and repeat the procedure again.

Treatment of exostoses of fingers and toes

To relieve pain and inflammation, patients are prescribed drug therapy. It is selected individually depending on the complexity of the situation and the nature of the patient’s chronic diseases. Most often, NSAIDs are prescribed in the form of ointments, gels, creams or oral forms. But their use does not lead to the resorption of the osteochondral growth, but only helps to eliminate the symptoms.

The only effective way to treat exostosis of the phalanx of the finger is surgery. It is shown when:

• large amounts of exostosis;
• finger deformities;
• persistent pain syndrome;
• the development of complications or the appearance of signs of malignancy.

The operation is not technically difficult and can even be performed under local anesthesia. They mainly resort to the method of marginal resection of the tumor. It involves making a transverse incision in the projection of the bone growth. Its magnitude depends on the size of the formation, but is usually on the order of several millimeters. The soft tissue is carefully separated from the bone to obtain a clear view of the exostosis and accurately determine its boundaries.

After this, using a surgical chisel or other instrument, the growth is carefully removed within healthy tissue. It is important for the surgeon to completely remove the entire tumor along with its cartilaginous cap, since otherwise there is a high risk of relapse. The surgical wound is actively washed with saline to wash out the smallest bone particles, and only then is it sutured and covered with a sterile bandage.

If a patient is diagnosed with deformity of the phalanges of the fingers, a corrective osteotomy is indicated. The operation involves not only removing the osteochondral exostosis, but also cutting the bone, followed by juxtaposition of the resulting fragments in such a position that the phalanx acquires an anatomically correct shape. The bone is fixed with special metal systems in a given position, after which the wound is sutured and covered with a sterile bandage.

Treatment methods for a broken finger

Rehabilitation

The duration and complexity of the recovery period are determined by the type of surgery performed. After marginal resection, discharge can be carried out on the day of surgery, but patients are advised to limit physical activity for 2 days. Drug therapy is also prescribed to reduce the risk of developing infectious complications and eliminate pain. After 2 days, a dressing is required, the stitches are removed after 7-10 days.

When performing a corrective osteotomy, recovery is more complex and lengthy. It involves immobilization of the operated finger, which is necessary for the healing of an artificial fracture.

Thus, exostoses of the fingers and toes are a rare phenomenon, but can significantly reduce the level of physical activity, cause cosmetic defects, pain, and generally worsen the quality of life. The solution to the problem is only possible through surgery. In this case, the operation is usually simple and does not require complex recovery. The main thing is to contact an orthopedic traumatologist as soon as possible after signs of exostosis appear, before its active growth provokes deformation of the fingers.

What are the types of phalangeal fractures?

Fractures of the phalanges of the fingers are divided according to several criteria:

• Location. Treatment for injuries of the nail, middle and main phalanx differs. There are many subtleties in the approach to fractures of the thumb - the most important element of the hand.
• Relation to the joint. Extra-articular fractures heal easier and faster than those located inside the joint.
• Displacement and number of fragments. Fractures are distinguished without displacement and with displacement of fragments. In comminuted fractures, the bone is divided into more than 2 fragments.
• Skin integrity. Most fractures are closed - the skin is intact. With open fractures there is a risk of infection and suppuration.

In order for the injury to have a minimal impact on future performance, it is important to provide first aid correctly and follow further doctor’s recommendations. Next, we will tell you what everyone needs to do after a bruise or fracture of the phalanx. At the end of the article are the best orthoses for first aid and professional treatment.

Toe deformity

Hallux valgus (valgus deformity of the first toe)

The most common disease of the big toe is hallux valgus.
According to scientists, the incidence of this condition in people aged 18-65 years is 23%, and in patients over 65 years old - 35%. The deformity is more common among women. Hallux valgus is partly a hereditary problem - most patients with this deformity usually have older relatives in the family who also suffer or have suffered from this condition. Hallux valgus deformity of the first toe is extremely easy to diagnose even during an external examination. However, it should be noted that hallux valgus can exist simultaneously with another condition, which in turn can manifest itself as pain in the first toe: hallux rigidus, sesamoiditis, turf toe or gout. Therefore, even in patients with obvious hallux valgus deformity, a thorough medical history and examination is required.

Hallux rigidus (arthrosis of the big toe)

Hallux rigidus occurs in 2.2% of people aged 55 years and older. This is the second most common disease of the big toe. Both feet are often affected, and the average age of onset of symptoms of the disease ranges from 12-57 years, although it is more common in the older age group.

A rigid first toe is characterized by pain along the dorsum of the metatarsophalangeal joint, especially with movement.

On X-ray examination, hallux rigidus is characterized by the formation of osteophytes on the back of the head of the first metatarsal bone and narrowing of the joint space of the big toe joint.

Sesamoiditis

Injuries to the sesamoid bones account for 9% of all foot and ankle injuries and 1.2% of sports injuries. Chronic lesions of the sesamoid bones are usually more common in more physically active patients. Sesamoiditis is more common in adolescence and young adulthood.

While the diagnosis of hallux valgus is quite simple, sesamoiditis is often a diagnosis of exclusion. This means that we can talk about sesamoiditis only when all other diseases and injuries of the foot are rejected. We can think about sesamoiditis if we are faced with a physically active patient who has noted a change in the type of physical activity and footwear used in the recent past.

Pain with sesamoiditis is quite varied in its manifestations, but most often the patient can localize it quite clearly - in the projection of one or both sesamoid bones of the first metatarsophalangeal joint

Peat finger

According to the results of foreign studies, the increase in the frequency of hyperextension (extensor) injuries of the big toe (turf toe) is associated with the more frequent use of artificial soil in stadiums in recent years and the use of softer shoes by athletes. This condition is most common among American football players, as well as basketball players, soccer players, dancers, tennis players, volleyball players, and wrestlers. It can occur in people of any age, gender or ethnicity.

If an athlete comes to us and tells us about a fresh injury to the big toe that has arisen as a result of its sudden hyperextension, then with almost complete certainty we can think of a turf toe. However, this is a fairly broad category of injuries, characterized by varying degrees of injury to the capsule of the first metatarsophalangeal joint: from thinning of the capsule (plantar plate) to its complete rupture.

In these patients, X-rays are ordered to rule out other injuries to the metatarsophalangeal joint, such as sesamoid fractures or other fractures in the area of ​​the first toe.

Gout

Gout is the most common inflammatory joint disease and its incidence continues to rise. Possible reasons for the increase in incidence are the aging population and the increase in the incidence of chronic kidney diseases. Almost only men under the age of 50 suffer from this disease. In women, an increase in the level of uric acid in the blood serum occurs with the onset of menopause, so in women this disease occurs at an older age. Children get sick extremely rarely; in them, the disease can be caused by genetic mutations leading to changes in the metabolism of uric acid. The overall incidence of gout in the Russian Federation is about 3%, but in the elderly population its frequency reaches 10% or more.

A single attack of gout may be accompanied by only acute pain, but usually this pain gradually passes without any intervention.

The most significant alternative condition that a physician will rule out in a patient with an acute attack of gout, especially if one joint is affected, is infectious arthritis.

An incorrect diagnosis of a joint infection can have very disastrous consequences.

In case of multi-articular gouty lesions, especially inflammation of the joints of the hand, rheumatoid arthritis is always excluded.