ABSTRACT
Onychalgia comes from the rich innervation of the terminal phalanx, with 60% of digital nerve axons. Ungual pain develops in the context of a unique anatomic conguration: the absence of subcutaneous tissue between the plate and the underlying bony phalanx, added to the presence of brous collagenic bers rmly attaching the plate to the terminal phalanx, thus making the subungual space virtual, without possible dilation. With the help of the parents, the anamnesis aims to qualify the pain: its way of development (quick, progressive, insidious); its type (continuous, repetitive, throbbing); its intensity (acute, moderate, mild); its rhythm (diurnal, nocturnal); and the existence of precipitating, aggravating, or relieving factors (pressure, temperature, elevation of the limb, drug). A history of trauma of the nail apparatus should always be searched for. First-choice workup remains X-rays. Magnetic resonance imaging (MRI) may be helpful to precise a diagnosis and detail the anatomic boundaries of any solid tumor, facilitating the surgical approach. Avulsion allows biopsy or excision of the lesion.
