From the Guidelines
Onychogryphosis treatment should prioritize professional nail trimming by a podiatrist, with surgical nail avulsion and phenolization considered for severe cases, to improve quality of life and prevent complications 1.
Overview of Onychogryphosis
Onychogryphosis is a severe nail disorder characterized by extreme thickening, elongation, and curvature of the nail, often resembling a ram's horn or claw. This condition most commonly affects the toenails, particularly the big toe, and develops gradually over time.
Causes and Risk Factors
Onychogryphosis often results from neglected nail care, trauma, peripheral vascular disease, or fungal infections, such as onychomycosis 1. It's particularly common in elderly individuals with limited mobility or poor vision that prevents proper nail care.
Treatment and Management
Treatment typically involves professional nail trimming by a podiatrist using specialized tools. For severe cases, surgical nail avulsion (complete removal) may be necessary, followed by phenolization to prevent regrowth of the deformed nail. Daily foot soaking in warm water with mild soap can help soften the nail before attempting any home maintenance. Patients should apply moisturizer around the nail but avoid the nail fold to prevent infection. Regular podiatric care is essential for management, especially for patients with diabetes or circulation problems who face higher risks of complications 1.
Importance of Treatment
It is essential to treat onychogryphosis, as it can have a significant impact on the quality of life of patients, causing discomfort, difficulty in wearing footwear and walking, cosmetic embarrassment, and lowered self-esteem 1. If left untreated, onychogryphosis can lead to further complications, such as the development of foot ulcers, osteomyelitis, cellulitis, and gangrene in diabetic patients.
Prevention of Recurrence
To prevent recurrence, patients should be advised to wear protective footwear, apply antifungal powders, and keep their nails as short as possible 1. It is also crucial to treat all infected family members simultaneously, as onychomycosis and tinea pedis are contagious.
From the Research
Definition and Characteristics of Onychogryphosis
- Onychogryphosis is a disorder of nail plate growth characterized by an opaque, yellow-brown thickening of the nail plate with associated gross hyperkeratosis, elongation, and increased curvature 2.
- The condition can cause pain, secondary complications, and cosmetic concerns, making it a relatively common and important condition 2.
- Onychogryphosis can be caused by repeated minor trauma to the foot, and it is commonly seen in clinical practice, particularly in older adults 3.
Etiology and Risk Factors
- Onychogryphosis is often associated with poor personal care, and it can be caused by a variety of factors, including trauma, peripheral circulation disorders, and diseases of the central nervous system 4.
- The condition can also be associated with self-neglect, homelessness, dementia, old age, and foot abnormalities, such as hallux valgus and elephantiasis 4.
- Onychogryphosis has been linked to dermatologic conditions, such as psoriasis and onychomycosis, as well as vascular disease, including peripheral vascular disease and venous varices 5.
Diagnosis and Treatment
- The diagnosis of onychogryphosis can be difficult to identify in the early stages, as hypertrophy of the nail plate is the earliest manifestation, with more classical features appearing later 4.
- Treatment options for onychogryphosis include surgical procedures, such as total matricectomy, and subcutaneous flap coverage 3.
- A rational treatment protocol should be based on basic surgical principles, anatomy of the nail bed, and etiological factors, and may involve a combination of surgical and non-surgical approaches 6.
Associated Conditions and Complications
- Onychogryphosis has been associated with a range of conditions, including psoriasis, onychomycosis, hallux malleus, hallux valgus, peripheral vascular disease, lower extremity ulcers, and type II diabetes mellitus 5.
- The condition can result in significant morbidity, including pain, paronychia, and onychogryphosis, and can have a significant impact on quality of life 2, 5.