Surgical intervention for congenital nail fold hypertrophy

Congenital nail fold hypertrophy of the hallux is an uncommon abnormality affecting the periungual soft tissue of the great toe. It is usually identified at birth or shortly thereafter, and is known to spontaneously resolve in most cases. In this report, we describe the case of a 14-month-old boy presenting with nail fold hypertrophy of both great toes. The completely united skin bridge covering the nail on the right was excised and the nail folds recreated, with debulking of the left hypertrophic nail fold. We propose that management should be conservative in the first instance and that surgery should be reserved for cases in which 1) inflammation is unresponsive to conservative measures, 2) there is a dense condensation of tissue crossing the nail surface, or 3) there is significant hypertrophy persisting past 1 year of age with no signs of resolution.