• Improper nail trimming/hygiene appears to be the most common etiology

• Tight-fitting shoes

• Hyperhidrosis (excessive sweating)

• Trauma (activity such as soccer/sports)

• Genetics resulting in abnormal nail shape, pincer-nail deformity, wide nail plates, congenital malalignment of the toenails

• Bone abnormalities that increase the internal pressure in the ankle, foot, or toe might play a role as well

Symptoms may begin as a mild ache or stiffness in the back of the leg or above the heel after activity. Overtime this pain may increase and occur during/after running, jumping, stair climbing or sprinting.

Conservative Treatment

• Keeping nails cut short and straight across

• Epsom salt soaks

• Treating underlying infection if present

• Management of the underlying factors (hyperhidrosis, onychomycosis).

• Slant back procedure (removing offending edge of nail

• Taping procedures/Nail braces (ex onyfix)

Surgical Techniques

• Partial or total matrixectomy: This consists of excising the affected nail portion or entire nail plate

• Chemical partial matrixectomy: Removal of offending nail, and placement of phenol to prevent nail re-growth. This procedure demonstrates a higher success rate

• Other techniques: Newer techniques, including electrocautery, radiofrequency ablation, and carbon dioxide laser ablation