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Onychogryphosis (Ram’s Horn Nails) – What You Should Do

Reviewed by
Dr. Michelle Heiring

Onychogryphosis, also known as “ram’s horn nails,” is a condition in which the toenails become thickened and the curve of the nails becomes more severe, making them difficult to cut and causing them to grow into a long, curved shape resembling a ram’s horn.

The difficulty of trimming the nail is often exacerbated by neglect—one of the very things that sometimes brings the condition about in the first place. For this reason, the elderly are especially prone to onychogryphosis.

Symptoms of Onychogryphosis To Pay Attention To

To say that the toenail “thickens” does not adequately describe the more severe cases of this condition. In some of these cases the toenail indeed looks more like a horn than a nail; it is yellowish-brown in color, and no longer flat, so trimming it with nail clippers or scissors is out of the question.

Why Do I Have Onychogryphosis?

The most common cause of this kind of nail growth is believed to be chronic neglect. Elderly people in particular can sometimes become absent-minded and indifferent to their health, causing them to become less conscientious about trimming their nails. (In some cases the task of nail trimming may become difficult for us as we get older, due to conditions such as arthritis.)

Another possible cause of onychogryphosis is pressure on the nail over an extended period, such as may be caused by poorly fitted shoes.

This pressure causes the toenail to grow unevenly; one side of the nail grows faster than the other.

Other suspected causes of onychogryphosis include:

In rare cases, onychogryphosis may even be congenital (present from birth) and genetic in origin.

What Are The Risk Factors for Onychogryphosis?

The greatest risk factor for this condition appears to be age. If you have elderly relatives, keep an eye on their health, and try to become aware if they reach a point in their lives at which they are no longer able or willing to take care of themselves in basic ways.

If they are in the care of an institution such as a hospital or retirement home, make a point of visiting them regularly and seeing that their needs are being met by a podiatrist. Take note of the cleanliness of their surroundings, and inspect their feet if necessary.

The foregoing is not to suggest that only the elderly are at risk for onychogryphosis, which can also arise from injury.

If your work or hobbies routinely expose you to situations that may be dangerous for your feet—for example, if you spend a lot of time around horses—take reasonable precautions, and wear heavy, protective boots if possible.

Are There Complications of Onychogryphosis?

If onychogryphosis is left untreated, the nail can eventually grow into the skin, causing pain and inflammation, and creating a risk of bacterial infection.

Even if this does not happen, the unchecked growth of the nail can create an environment in which toenail fungus and other sorts of infections can appear.

Can Onychogryphosis Be Prevented?

The best way to prevent onychogryphosis is to trim your toenails regularly. Do not trim them in a curved shape; rather, cut straight across.

How Is Onychogryphosis Treated?

Surgical removal of the toenail (also known as avulsion of the nail plate) is a common treatment for onychogryphosis, and in some cases your doctor may even recommend a permanent nail removal, which is accomplished by destroying the nail matrix. (The nail matrix is the layer of cells at the root of the nail responsible for producing keratin, the material the nail is made of. In other words, the matrix creates the nail and causes it to grow.)

The procedure for removing a toenail is simple—the podiatrist injects a local anesthetic into your toe and simply removes (or avulses) the nail (imagining this may cause you to cringe a bit, but the operation should be relatively painless).

Following the removal of the nail plate, the next step may be the destruction of the nail matrix. This may be necessary if the condition is so severe (or has gone untreated for so long) that the nail matrix has been scarred and this scarring has permanently altered its orientation, making it impossible for the nail to ever grow properly again.

A nail that is allowed to grow from a matrix that has been damaged in this way will continue to thicken as before and may not adhere properly to the nail bed.

If your doctor has determined that it is necessary to destroy the nail matrix after removing your toenail, he or she will coat the matrix with a chemical agent (phenol or sodium hydroxide are the most commonly used chemicals for this purpose).

This procedure is known as a partial or full matrixectomy, or permanent nail removal.

What Is The Overall Prognosis for Onychogryphosis?

If onychogryphosis is treated before it has advanced too far, the patient stands an excellent chance of avoiding the pain, inflammation, and various infections that might otherwise result.

Medical References:

    Nails Magazine Podiatry Today The British National Health Service Obgyn News Tosti, A; Piraccini, BM (2008). "Chapter 70 – Nail Disorders". In Bolognia, JL; Jorizzo, JL; Rapini, RP. Dermatology 1 (2nd ed.). St. Louis: Mosby Elsevier. James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders.. Ram’s horn nails, Dr Nicola Mumoli (cardiologist) - Department of Internal Medicine, Ospedale Civile Livorno, Livorno, Italy, reported in Medical Journal of Australia, MJA 2011; 195 (4): 202, 15 August 2011, Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill.

This page was last updated on October 2nd, 2015

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