#787 Can the toenail grow back if the root of the nail is removed by biopsy? - DOC

#787 Can the toenail grow back if the root of the nail is removed by biopsy?

Can the toenail grow back normally if you remove part of the root of the nail because you had a biopsy? Well, that’s what we’re talking about today on the Doc On The Run Podcast.



Bruised toenails are extremely common in runners. We all beat up our nails and get black and blue toenails and truthfully many of us consider it like a rite of passage when you’re training for a marathon. However, sometimes you can actually get a linear streak, a straight line in the nail that is really concerning to dermatologists and podiatrists because if you get a just a straight line that stays there and doesn’t go away, it doesn’t drift out like a typical bruise under the nail usually does, your doctor might be concerned that you have something called Acral-lentiginous melanoma.

What that is and specifically what type of melanoma doesn’t matter all that much. The point is it’s extremely deadly, and you have to biopsy it. And when we biopsy it, a lot of times it grows from the root of the nail right under the skin. So, where the lunula, the little sort of curved part, like if you look at your thumb, you’ll see that there’s at the base of the nail, there’s sort of this halfmoon shaped piece that’s kind of lighter color, that’s the lunula. That is some of the matrix or root of the nail where the nail actually grows out from and underneath the skinfold is the rest of it.

So, depending upon where the streak starts is where your doctor will typically biopsy it. And if you take a punch biopsy and we poke a hole through the nail plate and take the piece of nail and the tissue underneath it out of there, or if your doctor cuts out that section of nail and removes the matrix and then sends it off  for biopsy to make sure you don’t have cancer, well, you might be worried that your nails going to be funny looking.

Believe it or not, I had a patient one time who was very, very worried about this. He came in for something else. He was a runner, and this was a long time ago. But when I saw him, I saw the streak in his nail and I said, “What is that?” He was like, that’s nothing that’s not why I’m here and I said well, it is something and he didn’t want to biopsy it. So, I had him sign a consent form saying he wouldn’t blame me if he died and that his family wouldn’t sue me.

Well, when I gave that to him to sign it, he was actually really concerned, and he wanted to know if this was a real problem. I said it is a real problem. This could be Acral-lentiginous melanoma and it could kill you. Biopsying it is the only reasonable thing to do. And so we went to the operating room, I took a punch biopsy that was around the base of the lesion, a little bit wider than the width of the discoloration in his nail. And sure enough, it came back as Acral-lentiginous melanoma but with clear margins.

In his case, it was fine. But, he was also really worried that if I took a biopsy and punched a hole right through the tissue, that it would wind up with basically two separate nails that the root of the nail would not grow back where we took that out. And that’s not typically what happens. So yes, it can be thicker. It can be damaged. It can look funny. That obviously is better than dying of cancer.

But last week I was at the International Foot and Ankle Foundation meeting in Las Vegas, and I was moderating a session and one of the doctors, a guy named Bryan Markinson, a World renowned podiatrist in terms of nail disorders and dermatology of Foot and Ankle. He was giving a talk, and he had some great pictures of before and after pictures where he had done these biopsies, and the nail is missing in this streak of maybe three millimeters, four millimeters wide. And then as the nail grows out over the course of a year, it basically fills in as the root of the nail regenerates and grows back.

Many of the pictures he had, aside from maybe a little divot in the end of the nail because it’s been about a year and it hadn’t completely grown out all the way, it looks great. And so yes, the root of the nail can regenerate itself in many cases when you do a biopsy because you’re concerned about that discolored streak that looks like a bruise but it’s just a straight line. Don’t be too freaked out and remember, if your doctor is recommending the biopsy, you probably ought to do the biopsy. It’s as simple as that.

If you’d liked this episode, please like it, please subscribe. If you have an injury and you’re wondering what to do to get back to training, check out the running injury quiz. It’s free. You can get a www.docontherun.com/runninginjuryquiz and you go through and it’ll ask you some very specific questions to give you some things to think about that you might not be considering that might help you get back to running a whole lot faster. Thanks. I’ll see you in the next training.