Effects of onychomycosis and subungual hyperkeratosis on foot aesthetics and function

Abstract

Aim: To evaluate foot function (Foot Function Index) and cosmetic satisfaction before surgery and at 12 months after surgical excision in patients with onychomycosis and subungual hyperkeratosis.

Method: We retrospectively evaluated consecutive patients who underwent surgical excision of hypertrophic mycotic toenails with subungual hyperkeratosis between March 2018 and January 2023 and completed 12 months of follow-up. We assessed pain, disability, and activity limitation using the Foot Function Index (FFI) preoperatively and at 12 months. We recorded cosmetic satisfaction on a 5-point Likert scale.

Results: Eleven patients (3 men, 8 women; mean age 60.6±13.9 years) underwent excision of 31 affected nails (mean 2.8±1.5 nails/patient). All wounds healed without complications, and all patients resumed wearing socks and regular shoes by postoperative week 2. Mean FFI pain, disability, and activity limitation scores decreased from 2.4±0.87, 2.9±0.76, and 3.4±1.07 preoperatively to 0.3±0.2, 0.2±0.2, and 0.0±0 at 12 months (all p < 0.001). Satisfaction increased from 1.5±0.7 to 5.0±0.5 (p < 0.001).

Conclusions: Surgical excision of severe hypertrophic mycotic toenails produced large improvements in foot function and high cosmetic satisfaction at 12 months.