Toenail neglect may lead to infection

By Dr Ian McColl

THESE ram’s horn nails are called onychogryphosis. The commonest cause is simply neglect when a person grows older.

Because of obesity or arthritis, many elderly patients are unable to reach their nails to cut them. In time, the nail grows asymmetrically into a curved horn which may then penetrate the skin causing infection, a major problem to a patient with diabetes.

Although deformed, these nails are not necessarily infected by fungi. Cases are seen in patients with psoriasis and those with peripheral vascular disease. This woman had an even bigger horn on her big toenail but it sheared off! 

The one pictured was trimmed with clippers; they are difficult to cut with scissors. Patients prone to this condition should see a podiatrist or have a visiting nurse trim their nails regularly. Poor-fitting footwear may contribute to this condition.

This article first appeared in Medical Observer on the 16th of September, 2015

THESE ram’s horn...

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