Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Township, MI
Last reviewed: May 2026
The most important clinical decision with Retronychia: The Ingrown Nail Variant That Goes Backward isn’t which treatment to choose — it’s identifying which subtype you have first. Our podiatrists see patients treated for the wrong subtype for months before the correct diagnosis leads to full resolution. Call (810) 206-1402 — expert podiatric care across Michigan.
Retronychia is an uncommon but distinct nail condition in which the proximal (base) edge of the nail plate embeds backward into the proximal nail fold — the skin overlying the base of the nail. Unlike typical ingrown toenails where the nail edge grows into the lateral nail groove, retronychia involves the base of the nail being forced proximally and upward into the posterior nail fold, causing chronic proximal nail fold inflammation, pain, and nail plate stacking.
How Retronychia Develops
Retronychia most commonly results from trauma that dislodges or disrupts normal nail growth — a stubbed toe, closed-toe shoe trauma, or acute nail plate injury. When the nail plate is pushed proximally, new nail growth from the matrix continues and stacks underneath the older, retrograde nail plate. This creates a characteristic “nail stacking” appearance with multiple nail plates visible on inspection.
Retronychia vs. Standard Ingrown Toenail
| Feature | Standard Ingrown Nail | Retronychia |
|---|---|---|
| Location of pain | Lateral nail groove(s) | Proximal nail fold (base of nail, not sides) |
| Nail plate direction | Side edges growing into groove | Base of nail forced proximally into posterior fold |
| Nail stacking | Absent | Present — multiple layers of nail plate visible |
| Cause | Nail curvature; improper trimming; tight shoes | Trauma; acute nail plate displacement proximally |
| Granulation tissue location | Lateral folds | Proximal fold; may be absent early |
| Treatment approach | Lateral nail avulsion; partial matrixectomy | Complete nail plate avulsion (often both plates in stack); proximal fold release |
Treatment: Why Conservative Care Fails
Retronychia does not resolve with topical antibiotics, nail braces, or the standard ingrown nail management because the underlying stacked plates continue to mechanically compress the proximal fold regardless of local treatment. Definitive treatment requires complete nail plate avulsion to remove all stacked plates, allowing the nail matrix to regrow a single unobstructed nail plate. In most cases, the proximal nail fold inflammation resolves once the mechanical cause is removed.
Recovery After Nail Avulsion for Retronychia
| Phase | Timeline | Expectation |
|---|---|---|
| Immediate post-avulsion | 0-2 weeks | Wound healing; daily dressing changes; soaking |
| Early regrowth | 2-8 weeks | New nail plate begins emerging from matrix |
| Full nail regrowth (hallux) | 9-12 months | Complete nail plate replacement |
| Recurrence prevention | Ongoing | Proper footwear; avoid toe trauma; proper nail care |
At Balance Foot & Ankle in Howell and Bloomfield Township, we diagnose and treat retronychia with in-office nail avulsion under local anesthesia. Call (810) 206-1402.
American Academy of Dermatology: Nail Conditions
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Doctor Answer
What is retronychia and how is it treated?
Retronychia is proximal nail embedding where a new nail plate grows under the old plate rather than pushing it forward, causing painful nail fold inflammation at the base of the nail. It most commonly affects the big toenails of runners and athletes from repetitive micro-trauma. I treat it by removing the retained old nail plate (avulsion) under local anesthesia, allowing the new nail to grow forward normally. Without treatment, the condition persists with ongoing nail fold pain and infection risk.
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.