Photo Quiz

Acquired Nail Disorder in an Older Person


Am Fam Physician. 2017 Apr 15;95(8):519-520.

A 78-year-old man who had not seen a physician in many years had pain in his feet, but no history of trauma. He wore sneakers and was able to walk well without a cane or walker. He had not cut his toenails for an extended period and had poor hygiene. He was independent in activities of daily living. He had no relevant medical history and was not taking medications.

On physical examination, his lower extremities were cool with thin, dry, and scaly skin. Bilateral thick, elongated, and curved toenails 5 to 8 cm long were digging into the skin (Figure 1). Keratin debris was noted over the toes and interdigital spaces, and there was trace pitting edema on both legs. Dorsalis pedis pulses were diminished bilaterally. Sensation was grossly decreased to light touch.

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Figure 1.

Figure 1.


Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Onychauxis.

B. Ony

Address correspondence to Jinal Gangar, MD, MPH, at Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


show all references

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4. Singh G, Haneef NS, Uday A. Nail changes and disorders among the elderly. Indian J Dermatol Venereol Leprol. 2005;71(6):386–392.

5. Fowler AW. Excision of the germinal matrix: a unified treatment for embedded toe-nail and onychogryphosis. Br J Surg. 1958;45(192):382–387.

6. Kaplan I, Labandter H. Onychogryphosis treated with the CO2 surgical laser. Br J Surg. 1976;29(1):102–103.

7. Andrew T, Wallace WA. Nail bed ablation—excise or cauterise? A controlled study. Br Med J. 1979;1(6177):1539.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

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