Male

Hi everyone, I’m looking for medical opinions or clinical insights from dermatologists, podiatrists, or foot surgeons regarding a persistent issue with my big toe.

April: Started experiencing severe pain in the top part of my big toe, both upon touch and occasionally at rest. An initial orthopedist visit with X-rays showed reduced joint cartilage, and it was diagnosed as localized nerve inflammation (neuritis). I was prescribed Vitamin B12 (3x/day) for nerve healing and told it could take months to resolve.

Early July: Pain persisted, the cuticle disappeared, nail growth completely stopped (nail-growth arrest), and severe localized inflammation with mild swelling developed.

July (Dermatologist): Diagnosed as a bacterial infection/paronychia. I completed a 3-week course of oral antibiotics along with a topical antibiotic cream. After 3 weeks, the swelling and diffuse redness decreased significantly, but severe tenderness to touch remained localized strictly at the proximal nail fold (where the nail grows).

Late July (Hospital Orthopedist): Repeat X-rays confirmed the bone and joint structures are 100% normal (no fractures, no subungual exostosis, no osteomyelitis).

Current Status (Plastic Surgeon / Foot Specialist): Given the history of nail-growth arrest and localized proximal inflammation, I suspected Retronychia. I brought this up with a specialist who agreed it is a strong possibility. 

The current plan is an outpatient procedure to debride the hyperkeratotic tissue / pseudo-cuticle formed at the base, and evaluate whether a partial or total nail plate avulsion is required during the procedure.

Current Symptoms:

Prominent redness and swelling at the proximal nail fold (base of the nail).

Marked pain/tenderness to light touch directly over the nail matrix / eponychium.

Pain when applying retrograde pressure (pressing on the distal tip of the nail, pushing it backwards toward the matrix).

Based on the photo and history, does this clinical presentation strongly align with Retronychia?

Are there any other differentials I should consider or discuss with my surgeon before proceeding with the intervention?

Thank you in advance.

Chronic big toe pain & proximal fold inflammation for 4 months