BH12 Management of pincer nail deformity through nailbed plasty with osteophyte excision and double Z-plasty

Abstract

Pincer nail deformities present as excessive transverse curvature of the nail plate, leading to compression of the nailbed and surrounding soft tissue. This condition causes functional limitations, significant pain and cosmetic concerns. Conservative treatment may provide temporary relief. However, most cases, especially those that are severe and recurrent, require definitive surgical correction. Nevertheless, many existing surgical methods fail to address the underlying pathology, leading to high recurrence rates, or have suboptimal aesthetic outcomes. We present a surgical approach combining nail avulsion, osteophyte removal and double Z-plasty nailbed repair for the correction of pincer nail deformities and report the clinical and cosmetic outcomes. Between 2023 and 2024, three patients with severe hallux pincer nails, pain rating 7–8 out of 10, nail widths 6–12 mm and prior conservative treatment failure, underwent surgery with the proposed techniques. Clinical assessment, photographic documentation and patient-reported outcomes were recorded over 6 months. All patients reported pain relief and functional improvement within 4 weeks. Nail regrowth demonstrated normal curvature, and cosmetic outcomes were rated highly by patients. No postoperative complications or revisions were required. This combined surgical approach is safe and effective for correction of severe pincer nail deformities, with long-term beneficial outcomes. By addressing nail plate, soft-tissue and bony abnormalities, the technique preserves nail function while achieving favourable aesthetic results.