Modified Howard–Dubois Procedure Combined with Low-Level Laser Therapy for Nail and Distal Toe Hypertrophy: A Case Report with Three-Year Follow-Up
Marion Yau1*, Sahar Abolhassani2, Smit Christian2, Joseph Olivelle2
1Harley Medical Foot and Nail Laser Clinic, London, England, United Kingdom.
2Foot and Ankle Centre, London, England, United Kingdom.
*Corresponding Author: Marion Yau, Harley Medical Foot and Nail Laser Clinic, London, England, United Kingdom.
https://doi.org/10.58624/SVOAOR.2026.06.017
Received: May 27, 2026
Published: July 07, 2026
Citation: Yau M, Abolhassani S, Christian S, Olivelle J. Modified Howard–Dubois Procedure Combined with Low-Level Laser Therapy for Nail and Distal Toe Hypertrophy: A Case Report with Three-Year Follow-Up. SVOA Orthopaedics 2026, 6:4, 114-120. doi: 10.58624/SVOAOR.2026.06.017
Abstract
Background: Distal nail embedding (DNE) is a rare variant of onychocryptosis characterised by obstruction of distal nail growth by hypertrophic soft tissue, with or without underlying osseous prominence. It can lead to pain, nail deformity, and functional limitation.
Case Presentation: A 29-year-old female presented with chronic DNE of the right hallux associated with nail dystrophy, recurrent onycholysis, and onychomycosis, resulting in significant functional impairment. Conservative and antifungal treatments had failed.
Intervention: A modified Howard–Dubois procedure, including distal soft tissue resection, dorsal distal phalanx contouring, and nail avulsion, was performed under local anaesthesia. Following wound healing, low-level laser therapy (LLLT) was used to support nail regeneration.
Results: At three-year follow-up, sustained restoration of nail morphology and hallux contour was observed, with no recurrence of distal embedding or hypertrophy. The nail demonstrated normal adherence and appearance, with excellent functional and cosmetic outcomes.
Conclusion: This case highlights the potential role of combining a modified Howard–Dubois procedure with adjunctive LLLT in achieving long-term correction and nail regeneration in complex DNE.
Keywords: Distal Nail Embedding; Modified Howard Dubois; Hyponychium hypertrophy; Distal phalanx contouring; Low-level laser therapy; Nail regeneration; Nail dystrophy.