Acta Scientific Orthopaedics (ISSN: 2581-8635)

Case Report Volume 6 Issue 5

Subungual Exostosis of the Hallux: A Solution Through Percutaneous Surgery

León-Román Víctor Estuardo1,3*, López-Torres Irene Isabel2,3, Salas Quispe Alejandro Arturo1, Nuñez-García Ana1 and García- Prieto Esteban1

1Department of Traumatology and Orthopaedics Research, Villalba General Hospital, Carretera de Alpedrete a Moralzarzal, Madrid, Spain
2Fundación Jiménez Díaz Hospital. Av. Reyes Católicos, Madrid, Spain
3Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Calle Avenida de reyes católicos, Madrid (Spain)

*Corresponding Author: León-Román Víctor Estuardo, Department of Traumatology and Orthopaedics Research, Villalba General Hospital, Carretera de Alpedrete a Moralzarzal, Madrid, Spain.

Received: March 15, 2023; Published: April 10, 2023


Background: Subungual exostosis of the hallux is an osteochondral tumor that causes pain and deformity, requiring surgical resection in many cases. Although several specialities treat this tumor, orthopaedic surgeons seem to be poorly versed in its management. Several removal techniques have been described, all of which are open, aggressive and with high complication rates. We present a percutaneous removal technique with minimal soft tissue injury and a low complication rate. Surgical technique: 12-year-old male presented with a painful exostosis of the hallux with severe deformity. Percutaneous forefoot surgery was used to marginally resect the lesion preserving the integrity of the nail matrix. With millimetric wounds, the tumor is detached from its bed, its base was resected and burned. The patient had no complications, unpainful recovery and no recurrences within two years.

Discussion: Multiple techniques have been described for the removal of this exostosis. The main difference between them is the way the wound is closed, ranging from healing by secondary intention to direct suturing between the skin and the nail. The complication rate is 40%, the most frequent being residual nail deformity, infection and recurrence. Our technique applies percutaneous surgery, performing minimal damage to the soft tissue and nail bed while achieving the marginal excision of the tumor with debridement of the implantation bed.

Conclusion: The excision of the subungual exostosis of the hallux can be performed safely and with a low complication rate through percutaneous surgery, ensuring minimal incisions with little soft tissue damage.

Keywords: Subungual Exostosis of the Hallux; Percutaneous Surgical Technique; Forefoot Surgery; Tumor of the Hallux


  1. García Carmona FJ., et al. “A proposed subungual exostosis clinical classification and treatment plan”. Journal of the American Podiatric Medical Association 6 (2009): 519-524.
  2. Storlazzi CT., et al. “Rearrangement of the COL12A1 and COL4A5 genes in subungual exostosis: Molecular cytogenetic delineation of the tumor-specific translocation t (X;6) (q13-14; q22)”. International Journal of Cancer 8 (2006): 1972-1976.
  3. Zambrano E., et al. “Distinct Chromosomal Rearrangements in Subungual Exostosis (Dupuytren) and Parosteal Bizarre Proliferation Osteochondromatous Lesion (Nora)”. The American Journal of Surgical Pathology 8 (2004): 1033-1039.
  4. DaCambra MP., et al. “Subungual exostosis of the toes: A systematic review”. Clinical Orthopaedics and Related Research 4 (2014): 1251-1259.
  5. Schnirring-Judge M and Visser J. “Resection and Reconstruction of an Osteochondroma of the Hallux: A Review of Benign Bone Tumors and a Description of an Unusual Case”. The Journal of Foot and Ankle Surgery 4 (2009): 495-505.
  6. Pérez-Palma L., et al. “Subungual exostosis systematic review and meta-analysis”. Journal of the American Podiatric Medical Association 4 (2018): 320-333.
  7. De Berker DAR and Langtry J. “Treatment of subungual exostoses by elective day case surgery”. British Journal of Dermatology 5 (1999): 915-918.
  8. Pascoal D., et al. “Subungual exostosis - Treatment results with preservation of the nail bed”. Journal of Pediatric Orthopaedics B 4 (2020): 382-386.
  9. Davis DA and Cohen PR. “Subungual exostosis: Case report and review of the literature”. Pediatric Dermatology 3 (1996): 212-218.
  10. Suga H and Mukouda M. “Subungual exostosis: A review of 16 cases focusing on postoperative deformity of the nail”. Annals of Plastic Surgery 3 (2005): 272-275.
  11. Lokiec F., et al. “A simple and efficient surgical technique for subungual exostosis”. Journal of Pediatric Orthopaedics 1 (2001): 76-79.
  12. DaCambra MP., et al. “A novel management strategy for subungual exostosis”. BMJ Case Reports (2013): 10-13.
  13. Bauer T. “Percutaneous First Metatarsophalangeal Joint Fusion”. The Open Orthopaedics Journal 1 (2017): 724-731.
  14. Botezatu I., et al. “Minimally invasive-percutaneous surgery - recent developments of the foot surgery techniques”. Journal of Medicine and Life 8 (2015): 87-93.


Citation: León-Román Víctor Estuardo. “Subungual Exostosis of the Hallux: A Solution Through Percutaneous Surgery”.Acta Scientific Orthopaedics 6.5 (2023): 22-25.


Copyright: © 2023 León-Román Víctor Estuardo. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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