Ava Monroe
The accessory nail of the fifth toe, also known as a double nail of the fifth toe (DNFT) or a petaloid toenail, is a physical trait where a minuscule sixth toenail is present in the outer corner of the nail on the smallest toe. This condition is commonly observed in the Chinese population and is believed to be caused by genetics. While it does not usually require treatment, some people may opt for removal due to pain, discomfort, or cosmetic reasons. Removal methods include nail clippers, surgery, phenolization, or laser treatment.
| Characteristics | Values |
|---|---|
| Other names | Double nail of the fifth toe (DNFT), petaloid toenail, rudimentary nails, accessory nails |
| Description | A minuscule sixth toenail protruding outwards from the outer corner of the nail on the smallest toe |
| Prevalence | Common but underreported, especially in the Chinese population |
| Causes | Genetic, possibly inherited from a distant relative; can occur due to forgotten injury or trauma |
| Treatment | Can be cut with a nail clipper, though it will grow back; surgery (podiatric surgery, matricectomy, excision, or phenolization) is an option for permanent removal |
| Alternative treatments | Over-the-counter nail repair products, such as Vitry Nail Repair Care |
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What You'll Learn
Accessory nail of the fifth toe: What is it?
The accessory nail of the fifth toe, also known as a double nail of the fifth toe (DNFT) or a petaloid toenail, is a physical trait where a minuscule sixth toenail is present in the outer corner of the nail situated on the smallest toe. This trait can be observed on either one or both feet, with a lengthwise separation of the toenail on the corner of the smallest toe. The additional nail, which averages 2-7mm in length, can be cut with a nail clipper but will grow back. The entire nail of the small toe is usually short and wide, and both nails often share the same nail bed.
The accessory nail was first described in a 1969 paper by M. Hundeiker. Although it is understudied and underreported, its prevalence is common, and it is observed in people from all ethnicities and races, with no higher prevalence in one group over another. It is equally common in males and females but is stereotypically associated with Han Chinese people, with a prevalence in certain parts of China between 51% and 79%.
Chinese mythology and legends attribute the accessory nail to the story of a woman who was abducted and stabbed in the abdomen during the Huang-ti or Yellow Emperor Dynasty. She gave birth to two children with scarred feet, and their descendants were born with double nails on their small toes.
The cause of the accessory nail is not well understood due to a lack of research. However, genome-wide scans indicate that it is a heritable trait and could be autosomal dominant. The wide variance in the size and structure of the accessory nail suggests that it may be a complex trait influenced by multiple genes with minor genetic effects. In some cases, the accessory nail may result from trauma to the toenail or an injury to the toe.
While most people do not seek treatment for the accessory nail as it typically does not cause pain or interfere with daily activities, it can sometimes lead to discomfort or pain, especially when it protrudes vertically from the nail bed. Treatment options include surgical or chemical matricectomy (complete removal or destruction of the nail matrix). However, matricectomies are considered aggressive treatments and are generally avoided unless the condition is severe. Other options include simply trimming the nail with clippers or using products like Vitry Nail Repair Care to promote healing.
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When to remove it
The accessory nail of the fifth toe is a common condition, particularly in the Chinese population, and is not usually a serious issue. However, there are several reasons why someone may want to remove it.
Firstly, it can be removed for cosmetic reasons. The accessory nail is often wider than normal and divided by a longitudinal cleft, which may be undesirable aesthetically. In some cases, the nail can also cause pain and discomfort, especially when touched or when pressure is applied. If the accessory nail is constantly catching on clothes and socks, it can rip or tear, leading to open wounds that may get infected by bacteria and fungi. This can cause intense pain and may require medical attention.
If the accessory nail is causing such issues, there are a few removal options available. One option is to simply cut the additional nail with nail clippers, although it will grow back and require repeated procedures. For a more permanent solution, surgery is recommended. This can involve excision, or total nail removal, or phenolization, which involves destroying a part of the nail. A phenol matrixectomy, for example, is a simple procedure performed under local anaesthesia that permanently destroys the nail matrix. Another surgical option is a matricectomy, which has been shown to successfully treat the accessory nail of the fifth toe. This procedure involves incising the proximal nail fold, exposing and then excising the matrix of the accessory nail with a scalpel.
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Non-permanent removal methods
While there are no specific methods mentioned for the non-permanent removal of an accessory nail of the fifth toe, there are some general insights provided that can be considered. It is important to note that accessory toenails are an inherited, genetic trait, and any removal method will likely result in the nail growing back over time.
One option mentioned is to trim the accessory nail with nail clippers. This approach may provide temporary relief if the nail is causing discomfort or catching on clothing. However, trimming may not be a long-term solution as the nail will continue to grow back. It is also important to exercise caution when trimming to avoid injury or infection.
Some individuals have shared their experiences of manually removing the accessory nail, either by ripping it out or using tweezers. These methods are not recommended as they can be extremely painful and may lead to infections. Additionally, the nail will likely grow back, sometimes in a deformed or cracked state.
While not specifically mentioned as a removal method, it may be worth considering footwear that provides adequate space for the toes, reducing the likelihood of the accessory nail catching or causing discomfort.
It is important to consult a medical professional or podiatrist before attempting any removal methods, especially if the accessory nail is causing significant pain or impacting your quality of life. They can provide personalized advice and guidance on the most suitable approach for your specific situation.
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Permanent removal methods
If you are experiencing pain or discomfort due to your accessory nail, or if it is impacting your quality of life, it is recommended to consult a professional podiatric surgeon or a foot surgeon near you. While some people opt for permanent removal for cosmetic purposes, it is generally advised against removing the nail by yourself as it will not work—the condition is genetic, and the nail will grow back as it was. Moreover, attempting to rip out the extra toenail yourself will place you at high risk of fungal infections.
There are a few permanent removal methods for the accessory nail of the fifth toe, including surgical excision and matricectomy. Surgical excision involves the use of local anesthesia and a tourniquet to incise the proximal nail fold and expose the matrix of the accessory nail. The matrix is then excised using scalpel surgery, and the skin defect is repaired with a rotation flap. Another method is matricectomy, which is commonly performed and results in the permanent loss of that portion of the nail. It is considered an aggressive treatment and is generally avoided unless the nail condition is severe.
In addition to these methods, there are also other treatments available, such as vigorous curettage and electrofulguration of the matrices and beds of the nails. This method has been found to be effective, rapid, and acceptable for treating pachyonychia congenita. Removal of the nail beds is typically not necessary to prevent the recurrence of deformed nails, but it may be beneficial in reducing hyperkeratosis.
It is important to note that these procedures should only be performed by qualified medical professionals. While accessory nails may not always cause discomfort, they can lead to difficulty in diagnosis, so it is essential to thoroughly note their symptoms and occurrence patterns.
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Surgical matricectomy
A matricectomy is generally considered an aggressive treatment and is usually recommended only when the nail condition is severe, such as in the case of constant pain or frequent tearing of the nail. The procedure involves the partial or total removal of the nail, including the nail matrix, to prevent the issue from reoccurring. Before the surgery, the toe is properly cleansed and numbed with a local anesthetic. The doctor will then place a constricting band around the toe to reduce blood flow. Once the toe is numb, the surgeon will gently lift and remove the affected portion of the nail, cutting a straight line from the tip of the nail to the nail bed.
The nail matrix is then treated to prevent the issue from recurring. This treatment can be done through chemical applications, which prevent the nail cells in the matrix from growing back, resulting in a slightly narrower toenail. Alternatively, a phenol matrixectomy uses phenolization to destroy a part of the nail matrix and prevent regrowth. In some cases, a laser may also be used during the procedure.
After the matricectomy, the constricting band is removed, and the toe is bandaged and wrapped. The recovery time is relatively short, with the toe expected to be completely healed within a few weeks. The procedure is considered simple and efficient, with patient testimonials highlighting the pain-free and comfortable nature of the experience.
While surgical matricectomy offers a permanent solution, it is important to weigh the benefits against the potential risks and costs associated with the procedure. In some cases, non-surgical methods, such as nail clippers or over-the-counter treatments, may be preferred as initial approaches to manage the accessory nail of the fifth toe.
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Frequently asked questions
An accessory nail of the fifth toe, also known as a double nail of the fifth toe (DNFT) or a petaloid toenail, is a physical trait where a minuscule sixth toenail is present in the outer corner of the nail situated on the smallest toe.
The accessory nail can be removed with a nail clipper and will grow back. For permanent removal, surgery or phenolization (destroying a part of the nail) is recommended.
Surgical excision or matricectomy is the only treatment for permanent removal. Nail unit resection can be performed under local anesthesia. Other procedures include the use of lasers or chemicals.
If your accessory nail is constantly catching on your clothes and socks, causing it to painfully rip or tear, podiatric surgery may be a good idea. The open wound can cause bacteria and fungi to enter and cause further problems.
