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Onychogryphosis is a topic covered in the 5-Minute Clinical Consult.

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  • Onychogryphosis describes claw-like hypertrophy and thickening of the entire nail plate, involving most commonly the great toe, leading to severely distorted, brownish, spiraled nails detached from the nail bed.
  • The exaggerated growth of the nail is usually upward/lateral, with superficial transverse striations, and pain can be elicited with applied pressure.


Onychogryphosis occurs in 5% of the world population.

Etiology and Pathophysiology

  • The nail bed matrix produces the nail plate at uneven rates.
  • It is thought the faster growing side of uneven keratin production at the nail bed determines the direction of the nail deformity (1).
  • Several proposed theories for the cause of onychogryphosis:
    • Pressure or friction from footwear
    • Decreased perfusion secondary to peripheral vascular disorders
    • Onychomycosis
    • Self-neglect
    • Hallux valgus
  • Systemic diseases such as:
    • Ichthyosis
    • Psoriasis
    • Hyperuricemia
    • CNS diseases
    • Syphilis, pemphigus, and variola
    • Leishmaniasis
    • Hansen disease
  • Autosomal dominant condition, where the nails of the hands and the feet are involved, most notably in the 1st year of life

Autosomal dominant in some cases

Risk Factors

  • Playing high-friction sports, such as football
  • Older individuals
  • Subungual epidermophytosis
  • Hyperuricemia
  • Diabetes mellitus
  • Congenital malalignment of the great toenails (CMGT)

General Prevention

  • Avoid injuries to the fingers and toes.
  • Avoid compact footwear.
  • Avoid nail polish, as this causes trapping of moisture under the nail.

Commonly Associated Conditions

  • Psoriasis
  • Ichthyosis
  • Onychomycosis

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Stephens, Mark B., et al., editors. "Onychogryphosis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816263/all/Onychogryphosis.
Onychogryphosis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816263/all/Onychogryphosis. Accessed April 25, 2019.
Onychogryphosis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816263/all/Onychogryphosis
Onychogryphosis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 25]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816263/all/Onychogryphosis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Onychogryphosis ID - 816263 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816263/all/Onychogryphosis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -