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Narrow Shoes Thicken Nails. (Infectious Diseases).

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 in private practice in Jackson, Miss.

"The causative problem is the biomechanical situation in which the patient is trying to stick a big, fat foot into a narrow-toed shoe and using high heels, which jack the foot up, making the front of the foot spread out, and putting more pressure on the forefoot," he said.

Over the years, lateral shoe pressure can lead to a change in the orientation of the nail matrix, as well as changing the thickness of the nail plate. The seal between the nail plate and the nail bed is broken, allowing fungus to get into the nail unit. "So you've got a thickened nail that is due to trauma, and, secondarily, aggravated by fungus," he said.

Conservative treatment consists of urea cream, up to 40% concentration. "This decreases the rigidity, therefore, the splinter effect of the nail," he said. "It also makes the nail softer and easier to cut."
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Author:Kubetin, Sally Koch
Publication:OB GYN News
Date:Oct 15, 2001
Words:294
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