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Narrow Shoes Thicken Nails. (Infectious Diseases).

OB GYN News

| October 15, 2001 | Kubetin, Sally Koch | COPYRIGHT 2001 International Medical News Group. This material is published under license from the publisher through the Gale Group, Farmington Hills, Michigan.  All inquiries regarding rights should be directed to the Gale Group. (Hide copyright information)Copyright

Onychogryphosis due to biomechanical trauma from narrow-toed shoes with secondary onychomycosis is a frequently missed diagnosis, Dr. C. Ralph Daniel III said at the annual meeting of the American Academy of Dermatology.

Half of the nail disorders that show up in the physician's office are fungal in nature, he said, but many clinicians often fail to see the big picture, Dr. Daniel said.

He cited the case of a 58-year-old woman in otherwise good health who presented with a painful left great toe and a progressively thickening nail, which had not responded to oral or topical antifungals.

Fungal cultures revealed Trichophyton rubrum, but the tip-off for the primary diagnosis was narrow-toed shoes and bunions. Hence the chicken and the egg diagnosis. "The chicken is the secondary fungal infection, while the egg is the biomechanical problem," said Dr. Daniel, a dermatologist ...

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