Ava Monroe
Double nails, also known as retronychia, are an uncommon nail condition. It occurs when there is a disruption to a growing nail plate, often caused by trauma to the toe and nail plate. In some cases, another nail plate can emerge alongside the original, resulting in several plates stacked on top of each other. This condition can cause pain and inflammation as the nail grows into the proximal nail fold. While rare, double nails can also occur on the fingers, with some cases potentially caused by genetic factors.
| Characteristics | Values |
|---|---|
| Condition | Ingrown double nails, termed retronychia |
| Cause | Trauma to the toe and nail plate, or repeated micro-trauma from ill-fitting shoes or repetitive activities like dancing and jogging |
| Treatment | Surgical removal of the nail or nail plates |
| Healing Time | Quick, but a new 'normal' single nail plate will take 9-12 months to fully grow forward |
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What You'll Learn
- Double nails, also known as retronychia, are usually ingrown
- Retronychia is caused by a disruption to a growing nail plate
- Trauma is the main cause of retronychia, e.g. direct impact to the toe
- An accessory nail is a rare condition, often causing pain and discomfort
- Certain health conditions can damage the nail matrix and interfere with nail growth
Double nails, also known as retronychia, are usually ingrown
Certain underlying health conditions can also contribute to the development of retronychia. These include foot conditions that put extra pressure on the big toe, such as misalignment of the toenails. Additionally, research suggests that the natural shape of an individual's nails or feet may make them more susceptible to this condition. Retronychia is commonly misdiagnosed, and it is important to recognise its distinct symptoms and causes to improve diagnostic accuracy.
The early symptoms of retronychia include pain, redness, swelling, and changes in nail colour. In later stages, a new nail can start growing underneath the old nail, resulting in multiple layers of nails pushing against each other. This can lead to further complications, such as infection and impaired walking ability. Therefore, it is crucial to address retronychia promptly to prevent these issues.
The treatment for retronychia focuses on relieving symptoms and restoring normal nail growth. In the early stages, changing to better-fitting shoes with a wide toe box or open toes can help resolve the condition. Minimising activities that put constant pressure on the toes, such as running or dancing, can also reduce the risk of retronychia. However, if the condition persists, surgical intervention, known as nail avulsion, may be necessary. During this procedure, part or all of the damaged toenail is removed using a chemical solution or a scalpel.
It is important to note that even with surgical treatment, retronychia may recur. To prevent recurrence, individuals should continue wearing loose or open-toed shoes and ensure proper nail care. Additionally, monitoring new nail growth after treatment is crucial to address any potential issues promptly.
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Retronychia is caused by a disruption to a growing nail plate
Retronychia is a rare condition where the nail plate (the hard part of the nail made of the protein keratin) grows into the nail fold. This occurs when there is a disruption to the longitudinal growth of the nail, which can be caused by an acute injury or trauma, usually of a physical or systemic nature. This includes direct impact to the toe and nail plate, or repeated micro-traumas such as ill-fitting shoes, sports, or repetitive activities like dancing and jogging. In some cases, no triggers are identified.
The disruption to the nail's growth causes the separation of the old plate from the matrix and nail bed, leading to vertical growth into the proximal nail fold. This results in the stacking of multiple generations of new nail plates on top of each other under the old nail plate, as the growth of the new nail plate pushes the old nail upwards. This condition is often painful and can cause inflammation of the nail fold, yellow or white discoloration of the nail plate (xanthonychia), and the growth of new connective tissue (granulation tissue).
Retronychia is typically observed in the big toenails, but it can also affect the fingernails. It is more commonly seen in adult females, although it has been reported in children and the elderly as well. The condition is diagnosed based on its characteristic appearance, including the layers of stacked nail plates and the missing cuticle. Treatment options for acute retronychia include corticosteroids applied topically or injected into the nail.
To address retronychia, the nail plates need to be surgically removed to eliminate the source of irritation and allow the nail bed to heal. Following the removal, a single new plate is encouraged to grow forward. While the chances of recurrence are slight, it is important to address the underlying cause to prevent future episodes. This may involve identifying and addressing any biomechanical issues, such as locking the big toes while walking or having lowered medial arches (pronation), which can cause mechanical stress on the nail plates.
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Trauma is the main cause of retronychia, e.g. direct impact to the toe
Trauma is the most common cause of retronychia, a condition where the proximal nail plate grows into the proximal nail fold, resulting in multiple layers of nail plates. This is often associated with repeated minor injuries or microtrauma, such as poorly fitting shoes, sports activities like jogging or hiking, and the use of high-heeled shoes. These activities cause pressure against the free edge of the nail, leading to retronychia.
Retronychia typically affects the toenails, especially the big toe, and is less common on the fingernails. The condition is characterised by a yellow discoloration of the nail plate (xanthonychia), detachment of the nail plate from the nail bed (onycholysis), inflammation of the proximal nail fold, and the presence of inflammatory exudate and granulation tissue.
The underlying mechanism of retronychia involves the disruption of normal nail growth. Usually, the nail plate moves outward over the nail bed, and the new nail growth pushes the old nail plate out distally. However, in the case of retronychia, trauma or injury causes the separation of the old nail plate from the matrix and nail bed. This leads to vertical growth of the new nail plate into the proximal nail fold, resulting in multiple layers of nail plates.
The diagnosis of retronychia is based on clinical suspicion and the presence of unresolved chronic proximal paronychia, disrupted nail growth, and multiple generations of nail plates. A preliminary diagnosis can be made by recognising the characteristic appearance of the affected nail, including yellow discoloration, detachment of the nail plate, and inflammation. Nail avulsion is the diagnostic and curative procedure of choice, although relapses have been reported.
It is important to note that other conditions can also cause yellow nails, such as yellow nail syndrome, congenital malalignment of the nails, and onychomycosis. However, retronychia presents with distinct features, including yellow discoloration, onycholysis, inflammation, and the presence of granulation tissue and inflammatory exudate, which help differentiate it from other nail disorders.
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An accessory nail is a rare condition, often causing pain and discomfort
An accessory nail, or double nail, is a rare condition that can cause pain and discomfort. It is a type of surgical pathology that can affect the middle finger or the toes. In the case of the toes, an accessory nail is often referred to as a double nail of the fifth toe (DNFT) or a petaloid toenail. This condition results in a minuscule sixth toenail in the outer corner of the nail on the smallest toe. The additional nail protrudes outward from the corner of the main toenail and is typically 2-7mm in length. While some people may not experience any pain or symptoms that interfere with their daily lives, others may feel pain or discomfort, particularly when the accessory nail protrudes vertically from the nail bed.
The accessory nail of the middle finger is also an extremely rare condition. In one case, a 28-year-old male presented with an abnormal growth of the nail on his left middle finger, which was hard and pointed. The growth was made of keratinized material and was inseparable from the nail bed, causing pain and discomfort when touched.
The exact causes of accessory nails are not well understood, and there is limited data in the existing literature. However, some people with accessory nails have reported a positive family history, suggesting a possible genetic component. In most cases, patients cannot provide information regarding heredity or previous trauma.
Treatment for accessory nails typically involves surgical excision or chemical matricectomy (complete removal or destruction of the nail matrix). The nail unit resection procedure can be performed under local anesthesia to provide symptomatic relief and address cosmetic concerns. It is important to note that accessory nails can cause diagnostic confusion due to their rarity, so thorough documentation of symptoms and occurrence patterns is crucial.
While accessory nails themselves are rare, changes in nail appearance can occur due to various factors. Injuries, infections, and certain health conditions can all affect nail growth and appearance. For example, a heart attack, COVID-19, pneumonia, and chemotherapy can interrupt nail growth and cause horizontal ridges or Beau's lines. Skin conditions like severe eczema and psoriasis can also impact the nail matrix, leading to temporary nail growth interruption, Beau's lines, pitting, and texture or colour changes. Additionally, peripheral artery disease (PAD) can reduce blood flow to the legs and feet, slowing nail growth. Any changes in the appearance or texture of nails should be monitored, and medical advice should be sought if there are concerns.
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Certain health conditions can damage the nail matrix and interfere with nail growth
The nail matrix is the "factory" where your body makes new fingernails and toenails. It is made up of two parts: the germinal matrix, which is responsible for about 90% of nail growth, and the sterile matrix, which accounts for the remaining 10% of cells and is crucial for keeping the nail attached to the skin. The nail matrix is typically not visible, except for the lunula, the white crescent shape at the base of the nail.
Subungual melanoma, or nail matrix melanoma, is a type of skin cancer that affects the nail matrix. It causes cancerous cells to grow in the nail matrix, leading to pigment changes known as melanin. As a result, a distinct striped discolouration may appear on the nail. Other conditions like lichen planus, burns, and lupus erythematosus can cause pterygium unguis, which is scarring that extends to the nail matrix and gives the nails a ridged appearance.
In addition to skin conditions, infections can also damage the nail matrix. Bacterial, fungal, or viral infections can trigger inflammation of the matrix, weakening the nail. Nutritional deficiencies in biotin, zinc, and iron can also contribute to matrix damage and nail changes. Serious health events or illnesses, such as a heart attack, COVID-19, or pneumonia, can interrupt nail growth and cause Beau's lines.
Injuries to the nail matrix can also occur, leading to bruising, ridges, or discolouration. In some cases, the nail may fall off due to the injury. Pinching, crushing, or dropping something heavy on the finger or toe can all result in nail matrix injuries.
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Frequently asked questions
Double nails, or retronychia, are caused by a disruption to a growing nail plate. This is usually the result of trauma, such as a direct impact to the toe and nail plate, or repeated micro-trauma from ill-fitting shoes or repetitive activities like dancing and jogging. In some cases, it may be caused by an underlying medical condition.
Double nails can be painful and require medical attention. If you are experiencing pain or discomfort, you should consult a doctor or podiatrist. In some cases, surgery may be required to remove the nail plates and allow the nail bed to heal.
Double nails are an uncommon condition. However, they have been observed more frequently as ingrown nails, where the nail grows backward and causes pain and inflammation.
While there is no guaranteed way to prevent double nails, taking care to avoid trauma to the toes and wearing well-fitting shoes may help reduce the risk of developing this condition.
