Nail-Preserving Excision of a Fifth-Toe Subungual Osteochondroma Using a Modified Winograd Procedure: A Case Report

Subungual osteochondroma most frequently involves the hallux and commonly protrudes medially or dorsally. Atypical plantolaterally protruding subungual osteochondroma of a lesser toe is rare and presents a surgical challenge when associated with nail deformity. Conventional surgical treatment often requires complete nail removal followed by complete marginal mass excision. A 15-year-old male presented with progressive pain and nail deformity of the left fifth toe for 2 years, with a painful hyperkeratotic corn at the plantolateral side. A pedunculated osteochondroma at the plantolateral aspect of the fifth distal phalanx was identified on plain radiographs, computed tomography (CT), and magnetic resonance imaging (MRI). Using a modified Winograd procedure, complete marginal mass excision, partial nail preservation, and nail fold reconstruction were performed simultaneously, confirmed by histopathological examination. Wound healing was completed 2 weeks postoperatively without complications. At 3-month follow-up, the patient had fully returned to running and basketball with no clinical or radiographic evidence of early recurrence. This case report highlights that atypical plantolaterally protruding subungual osteochondroma of a lesser toe can be managed using a nail-preserving technique, with early functional recovery.