Onychogryphosis

This patient, a woman, presented with onychogryphosis, a severe nail change seen on the toes, especially the great toe. Thickening and hardening of the nail substance with a curved growth pattern produces this abnormal clawlike configuration.

Drs N. K. Akritidis, G. Mantzios, M. Mastora, and T. Papaxanthis of Ioannina, Greece, write that the pathogenesis of this appearance of the nail was permanent shoe pressure on the great toe, injuring the nail matrix. Other possible causes of this condition include hallus vagus and chronic venous insufficiency; epidermal dysplasias also may be associated with onychogryphosis.

Conservative therapy, such as filing the nail or applying concentrated urea paste, can relieve the condition, but nail removal or matrixectomy may be required in recalcitrant cases.