Enlarging, painful nodule under the toenail.

Volume 89, Number 10 www.aafp.org/afp American Family Physician 793 A 19-year-old woman presented with a slowly enlarging, painful nodule under her left great toenail that appeared two years earlier. She had attempted to remove part of the nodule on her own, but it grew back. She did not have a history of trauma to the area, but she noted increased pain when she wore tight or high-heeled shoes. The patient was a track athlete, and the pain of the nodule caused her to miss a season of competition. The physical examination revealed a tender 5-mm × 5-mm nodule under the medial side of the distal nail plate (Figure 1). The nodule was firm and displaced the nail plate upward. There was distal onycholysis, but no destruction of the overlying nail plate. No other toes were affected.