That Lump Next to Your Toenail: Could It Be More Than an Ingrown Nail?

Have you noticed a small lump or growth developing next to, or underneath, a toenail? While many people assume these growths are simply an ingrown toenail, excess skin, or a wart, they can occasionally be something called a periungual fibroma.

Although usually harmless, periungual fibromas can become uncomfortable, affect nail growth, and sometimes indicate an underlying medical condition. 

What Is a Periungual Fibroma?

A periungual fibroma is a benign (non-cancerous) fibrous tissue growth that develops around the nail unit, most commonly alongside or underneath a toenail.

These growths are made up of fibrous connective tissue and typically appear as:

• A flesh-coloured or pink lump
• A smooth or slightly rough growth near the nail
• A small, firm projection emerging from the nail fold
• A lesion that slowly increases in size over time

Periungual fibromas most commonly affect the big toe but can occur on any toe or finger.

What Causes a Periungual Fibroma?

In many cases, the exact cause is unknown. However, several factors may contribute:

Repeated Trauma

Repeated pressure or irritation from:

• Tight footwear
• Sporting activities
• Previous nail surgery
• Chronic rubbing or friction

may trigger the formation of a fibroma.

Underlying Medical Conditions

Multiple periungual fibromas may be associated with a rare genetic condition called Tuberous Sclerosis Complex (TSC). These are sometimes referred to as Koenen tumours.

For this reason, if several fibromas are present, further medical assessment may be recommended.

Symptoms of a Periungual Fibroma

Many periungual fibromas are painless, particularly when small. However, as they enlarge they may cause:

• Pain or tenderness when wearing shoes
• Difficulty cutting the nail
• Distortion or splitting of the nail plate
• Recurring inflammation
• Pressure discomfort
• Cosmetic concerns

Occasionally patients attend believing they have an ingrown toenail when the underlying problem is actually a periungual fibroma.

How Is a Periungual Fibroma Diagnosed?

At Foot Corner our podiatrist will usually begin with a detailed clinical examination.

Diagnosis may involve:

Clinical Assessment

Your podiatrist will examine:

• The appearance and location of the lesion
• Nail changes
• Symptoms and duration
• Previous trauma or nail procedures
• Whether similar lesions are present elsewhere

A dermatoscope (a specialised magnifying device) may be used to closely examine the lesion. This allows us to assess blood vessels, skin patterns, and distinguish a fibroma from other conditions.

Differential Diagnosis

Other conditions that can resemble a periungual fibroma include:

• Viral verrucae (warts)
• Pyogenic granuloma
• Ingrown toenail with granulation tissue
• Glomus tumour
• Digital mucous cyst
• Skin tags
• Subungual exostosis (bone spur)
• Squamous cell carcinoma
• Malignant melanoma

Because some nail lesions can occasionally be serious, any unusual or changing lesion should always be assessed by a healthcare professional.

Biopsy and Histology

In some cases, particularly if the diagnosis is uncertain or the lesion has unusual features, surgical removal and laboratory analysis (histology) may be recommended to confirm the diagnosis.

Treatment Options

Treatment depends on the size of the lesion, symptoms, and whether it is affecting the nail.

Monitoring

Small, symptom-free fibromas may simply be monitored over time.

No treatment may be necessary if the lesion is:

• Stable
• Painless
• Not affecting the nail or footwear

Where irritation is present, simple measures may help:

• Wearing wider footwear
• Reducing pressure on the area
• Padding or offloading devices
• Regular podiatry care to manage surrounding nail problems

Surgical Removal

If the lesion is painful, enlarging, repeatedly catching, or causing nail deformity, surgical excision is often the treatment of choice.

The procedure is usually performed under local anaesthetic and involves:

1. Numbing the toe.
2. Removing the fibroma.
3. In some cases, partially lifting or removing the nail to access the lesion.
4. Sending the tissue for histological examination.

Most patients recover well following surgery, although recurrence can occasionally occur.

When Should You Seek Professional Advice?

You should arrange an assessment if you notice:

• A new growth around the nail.
• A lesion that is increasing in size.
• Pain or bleeding.
• Nail distortion.
• Recurrent infection.
• Changes in colour, particularly dark pigmentation.

Early assessment helps ensure an accurate diagnosis and appropriate treatment.

How Can Foot Corner Help?

At Foot Corner, our podiatrists are experienced in assessing unusual nail and skin lesions affecting the feet. Using clinical examination and dermoscopy, we can help determine the cause of nail changes and advise whether monitoring, conservative treatment, or referral for further investigation is required.

If you have noticed an unusual lump or growth around your toenail, don't ignore it. Early assessment can provide reassurance and ensure the correct treatment is given.

To book an appointment, contact Foot Corner today.