Medically reviewed by Dr. Tom Biernacki, DPM — Board-certified foot & ankle surgeon, 3,000+ surgeries performed. Updated April 2026 with current clinical evidence. This article reflects real practice experience from Balance Foot & Ankle Specialists in Howell and Bloomfield Hills, Michigan.
Quick Answer
Most foot and ankle problems respond to conservative care — proper footwear, supportive inserts, activity modification, and targeted stretching — within 4-8 weeks. Persistent pain beyond that window, or any symptom that prevents walking, warrants a podiatric evaluation to rule out fracture, tendon tear, or systemic cause.
Watch: Dr. Tom Biernacki, DPM
Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Subungual exostosis — an outgrowth of normal bone (exostosis) or cartilage-capped bone (osteochondroma) arising from the distal phalanx and growing upward beneath the nail plate — is a benign but painful condition frequently misdiagnosed as an ingrown toenail, onychomycosis, or wart. The correct diagnosis requires a plain X-ray, and treatment is surgical excision — not nail treatments or antifungal therapy.
▶ Watch
Clinical Presentation and Diagnosis
Subungual exostosis most commonly affects the great toenail, with the distal and medial surfaces of the distal phalanx as the most common origin sites. Clinical features: a firm, sometimes tender mass beneath or at the distal nail border that elevates the nail plate and causes nail deformity; pain with shoe pressure; and occasional secondary nail infection or ulceration when the nail is severely elevated. The nail plate overlying the exostosis is often thickened, discolored, and partially separated from the nail bed — explaining why it is frequently misidentified as onychomycosis. The key diagnostic test is a plain radiograph: the lateral view of the distal phalanx demonstrates the bony protuberance arising from the dorsal phalanx cortex. Histologically, subungual exostosis consists of normal trabecular bone with a fibrocartilaginous cap — benign and not prone to malignant transformation, unlike subungual osteochondroma.
Surgical Excision
Surgical excision under digital block anesthesia: the overlying nail plate is avulsed to expose the nail bed and exostosis; the fibrocartilaginous cap is excised with a rongeur or curette; the bony base is smoothed with a bone file or burr to eliminate the entire pedicle and minimize recurrence risk. Recurrence occurs in approximately 10–15% of cases when excision is incomplete. The nail regrows over 9–18 months. The prognosis is excellent with complete excision — patients should expect a normal or near-normal nail appearance at final follow-up. Dr. Biernacki at Balance Foot & Ankle evaluates nail pain with X-ray at the initial visit — ensuring that subungual exostosis is identified and treated appropriately rather than subjected to repeated antifungal or ingrown toenail treatments that cannot address a bony lesion. Call (810) 206-1402 at our Bloomfield Hills or Howell office.
📧 Get Dr. Tom’s Free Lab Test Guide
Discover the 5 lab tests every person over 35 should ask their doctor about — explained in plain English by a board-certified physician.
📍 Located in Michigan?
Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
Comprehensive Nail Health Guide
The toenails are a window into your overall health. Changes in nail color, thickness, texture, or growth rate can signal local infection, systemic disease, or nutritional deficiency.
Common Nail Problems and Their Causes
- Thickened nails: Usually fungal infection (onychomycosis), but also trauma or psoriasis
- Yellow/brown nails: Fungal infection most common; also smoking, nail polish staining
- Vertical ridges: Normal aging; also low iron, B12 deficiency
- Horizontal ridges (Beau’s lines): Indicate systemic illness or nail trauma
- White spots: Usually minor trauma; less commonly zinc deficiency
- Spoon-shaped nails (koilonychia): Iron deficiency anemia
- Clubbing: Requires evaluation for heart or lung disease
Learn more about toenail fungus treatment and ingrown toenail treatment at Balance Foot & Ankle.
Related Conditions & Resources
Ready to Get Relief? We’re Here to Help.
Board-certified podiatrists Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients daily at our Howell and Bloomfield Township, MI offices.
📅 Book Online
📞 (810) 206-1402
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
Get Directions →
Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
Get Directions →
Your Board-Certified Podiatrists
Ready to Get Back on Your Feet?
Same-week appointments available at both locations.
Book Your AppointmentIn-Office Treatment at Balance Foot & Ankle
If home care isn’t resolving your your foot or ankle concern, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.
Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.
Most Common Mistake We See
The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.
Warning Signs That Need Same-Day Care
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- Unable to bear weight
- Severe swelling with skin colour change
- Fever with foot pain (possible infection)
- Diabetes plus any new foot symptom
Call (810) 206-1402 — same-day and next-day appointments at our Howell and Bloomfield Hills offices.
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon 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 reached over one million views.
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)
Recommended Products from Dr. Tom