PMC2649049_01
a AP photograph at the time of surgery (case 1). The nail has been completely overgrown by a large mass of tissue and the whole digit is grossly enlargerd. b Lateral photograph of the same toe. Chronic skin changes are visible and the swelling can be seen to extend to the level of the MTPJ.
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PMC2649049_01_1757-1626-2-102-1.jpg
F1
The nail was almost completely buried under a mass of inflamed tissue and the toe was particularly foul smelling (figure 1).
Plain oblique radiograph of the great toe (case 1). The size of the soft tissue swelling can be appreciated compared to the lesser toes and the distal part of the terminal phalanx has been eroded. There is also some calcification within the soft tissues volar to the distal phalanx.
1757-1626-2-102-2.jpg
PMC2649049_01_1757-1626-2-102-2.jpg
F2
Plain x-rays done at that time showed some bony erosion of the distal phalanx of the great toe and obvious soft tissue swelling (figure 2).
MRI scan of the great toe (case 1). As in the plain film, the end of the distal phalanx has been completely destroyed. There is signal change in the distal part of the proximal phalanx suggesting involvement of the bone more proximally.
1757-1626-2-102-3.jpg
PMC2649049_01_1757-1626-2-102-3.jpg
F3
An MRI scan was requested to determine the extent of the bony involvement and soft tissue disease (figure 3).
PMC2649049_02