Unravelling harpoon nail: Surgical outcome and insights

An ingrown toenail (onychocryptosis) is a chronic, painful condition, especially prevalent among adolescents. A rare variant, termed “harpoon nail,” involves a sharp spike of the nail plate penetrating deep tissue, causing inflammation and granulation tissue formation. Such cases are seldom reported in India, and improper nail cutting is the most common cause. This condition typically affects the hallux, particularly its outer edge, leading to a nail spur that pierces surrounding soft tissues, forming a channel. Factors such as trauma, excessive sweating, and tight shoes can exacerbate the condition by compressing the nail fold against the nail plate, sometimes leading to secondary bacterial infections. Here, we present a unique and rare case of a distal lateral ingrowing toenail-harpoon nail and its surgical management. A 28-year-old Indian female presented with severe pain and swelling in the left hallux for 5 years. Examination revealed hypertrophic soft tissue covering the distal nail plate, which extended 3 mm beyond this tissue. She was diagnosed with a harpoon nail due to hypertrophy of both lateral and distal nail folds. The modified Winograd technique was used for surgical correction and ablation of the germinal matrix was done by radiocautery. The procedure was minimally invasive, quick, and effective, resulting in high patient satisfaction and low recurrence rates. During follow-up visits, the patient reported no difficulty in wearing shoes, and her left hallux appeared normal and healthy, with proper alignment and no nail dystrophy. This case underscores the effectiveness of the modified Winograd technique in managing harpoon nails, providing both functional and cosmetic benefits.