Why Is My Big Toenail Small

Dr. Cole is from the Wayne State University School of Medicine, Detroit, Michigan. Drs. Huerta and Mancuso are from the Department of Dermatology, University of Michigan, Ann Arbor.

An 18-month-old girl presented for evaluation of nail dystrophy. The patient’s parents stated that the left great toenail had been dystrophic since birth, leading to skin irritation and “snagging” of the toenail on socks and footwear. Additional history revealed that the patient also had webbed toes, and there was a paternal family history of polydactyly and syndactyly. Physical examination revealed webbing of the second and third toes to the distal interphalangeal joints on both feet, marked nail plate dystrophy on the left big toe, and an irregularly shaped nail plate on the right big toe. The patient had no similar findings on the hands.

Radiographs of the feet demonstrated an accessory distal phalanx of the left great toe with a similar smaller accessory distal phalanx on the right great toe (Figure). The patient was referred to orthopedic surgery, and surgical intervention was recommended for only the left great toe given recurrent skin inflammation and nail complications. An excision of the left great toe polydactyly was performed. The patient healed well without complications.

South Burnett Podiatry

A, A radiograph revealed an accessory distal phalanx of the left great toe. B, A similar smaller accessory distal phalanx on the right great toe.

Many clinically heterogeneous phenotypes exist for polydactyly and syndactyly, which both are common entities with incidences of 1 in 700 to 1000 births and 1 in 2000 to 3000 births, respectively.

Both polydactyly and syndactyly can be an isolated variant in newborns or present with multiple concurrent malformations as part of a genetic syndrome, with more than 300 syndromic anomalies described. The genetic basis of these conditions is equally diverse, with homeobox genes, hedgehog pathways, fibroblast growth factors, and boneand cartilage-derived morphogenetic proteins implicated in their development.

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The differential diagnosis for our patient included congenital malalignment of the great toenails, nail-patella syndrome, onychodystrophy secondary to polydactyly, and congenital hypertrophy of the lateral nail fold. Given the strong family history, polydactyly was suspected.

One proposed mechanism of pathogenesis is desynchronization during growth of the nail and distal phalanx of the hallux, leading to larger nail plates that grow laterally.

Typical features associated with this disease are nail discoloration, nail plate thickening, and transversal grooves or ridges, none of which were seen in our patient.

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, which is responsible for dorsal-ventral patterning of the limb, as well as patterning of the nails, patellae and long bones, and even the kidney tubule.

As such, patients with nail-patella syndrome have associated renal abnormalities. The findings in our patient were limited to the feet, making an underlying syndrome unlikely to be the cause.

Fetal hydantoin syndrome is a well-documented sequela in women taking phenytoin throughout pregnancy. Multiple malformations are possible, including cardiac defects, cleft lip/palate, digit and nail hypoplasia, abnormal facial features, mental disability, and growth abnormalities.

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Congenital hypertrophy of the lateral nail fold is a defect of the soft tissue of the hallux leading to hypertrophy of the nail fold, commonly presenting with inflammation and pain

As demonstrated in our patient, family history can help guide the diagnosis. Seven of 9 nonsyndromic forms of syndactyly are inherited in an autosomal-dominant fashion and range from mild presentations, as in our patient, to more severe deformations with underlying bone fusion and functional impairment.

Polydactyly also often is expressed in an autosomal-dominant pattern, with up to 30% of patients having a positive family history. Polydactyly traditionally is classified by the location of the supernumerary digit as preaxial (radial), central, or postaxial (ulnar), and many further morphologic variations exist within these groups. Overall, preaxial polydactyly is relatively rare and represents 15% of polydactylies, with central and postaxial comprising the other 6% and 79%, respectively.

Signs Of Underlying Disease From Your Feet

Delineation of the underlying anatomy may reveal ray duplications (digit and corresponding metacarpal or metatarsal bone), metatarsal variants, and duplicated phalanges that may be hypoplastic or deformed. Patients may report difficulty finding comfortable footwear, cosmetic concerns, and nail-related complications. Although not always required, surgical intervention may provide definitive treatment but can leave residual deformities in the surrounding altered anatomy; thus, orthopedic or plastic surgery consultations are critical in appropriately counseling patients.Toenails! They aren’t just little shields for your toes, nor mere platforms for pretty nail polish. They can also act as a window to your overall health.

Certain toenail conditions can reveal at a glance whether your feet — and your body as a whole — are healthy. You can use these signs to clue you in on ways to take better care of your feet, your nails, and your whole body. If you happen to notice certain symptoms of a serious underlying condition, it’s a good idea to check in with a Salt Lake City podiatrist for an evaluation and personalized remedies.

One of the most common scenarios for toenails in ailing health is that they will thicken and take on a yellow or very light brownish tinge. This is an indication of toenail fungus. They may also become chalky, cloudy, or completely opaque. In severe cases, the nails may begin to crack and break or separate from the nail bed.

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Toenail fungus is an extremely common condition experienced by millions of Americans every year. The condition is rarely painful, but when left untreated leads to increasingly poor nail health. Advanced cases can see nails separating from the nailbed and possible secondary infections around the nail matrix and toe.

Treatment can consist of a combination of oral antifungal medications mixed with topical antifungals. Preventing new cases involves keeping feet sanitary, especially in communal showers or when sharing a bathroom with someone who has chronic nail fungus. Keeping your feet dry and diligently cutting toenails (always straight across) can prevent reinfection. You may need to choose new footwear that allows your feet to stay dry without being too tight or too loose, as well.

Ingrown toenails are another very common situation for millions of people. They most often occur when the nail has been trimmed too closely around the edges, creating a rounded spot where skin can grow over the top of the nail. Ingrown nails are also more likely to occur when a foot is enclosed in tight shoes or constantly kept moist.

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Good prevention is the best way to deal with ingrown toenails that keep coming back. Trim toenails straight across, leaving triangular-shaped edges that prevent skin from growing over the tops of the nails. Shoes should also be worn that aren’t tight-fitting and that allow the foot to breathe throughout the day. If your feet frequently become wet or sweaty, invest in Gore-Tex shoes and moisture-wicking socks. Only wear clean socks, and bring extra pairs for long work shifts or activities like hiking.

Treatment of current ingrown nails is best left to professionals. Do not attempt to “dig out” the nail, as this can cause further toe damage and swelling, inviting the infection to spread. For mild cases, you can try soaking the foot in a warm foot bath with Epsom salts and a bit of body wash, followed by keeping the foot dry and elevated. However, any time it is painful to walk and you notice pus/discharge and extreme discoloration of the toe, seek help from a podiatrist as soon as possible.

Toenail clubbing is a rare condition that most often indicates a serious underlying health issue. Most often, clubbing results from a lung disease or cancer says Mount Sinai hospitals . It can also indicate a condition like cirrhosis, dysentery, Graves disease, celiac, an overactive thyroid, or other forms of cancer.

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Clubbed toenails take on a distinctive rounded appearance. The nail will often bulge from the base of the nail bed, causing the nail edge to point downward. The edges of the nail may become flattened or wrap past the edge of the finger. Fingertips will bulge and may become white, red, or have a bluish tint.

Nail clubbing is a reaction to low blood oxygen levels or other abnormalities of the body. It should be taken seriously and evaluated by a podiatrist, who may refer you to an oncologist for further screening and review.

Nails can split, crack, or take on a cloudy appearance as a result of everyday activities. Minor trauma, such as can be caused by using nails to scratch at surfaces, can lead to these conditions. In some cases, nails that are constantly kept wet, being washed, or subject to harsh chemicals like acetone can take on these appearances.

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Beau lines are a specific condition marked by horizontal lines and subtle depressions in the nail surface. These can result from injury to the nail or the nail bed. One common reason for Beau lines is that the patient has been picking at their nailbed or cuticles, slowing nail growth temporarily. When normal growth is restored, the underdeveloped part of the nail stands out as a groove or line.

However, not all nail weaknesses can be traced back to outside factors. When nails have pitting, or holes in them, for example, this can be a sign of psoriasis. Individuals with alopecia — or hair loss — may also experience