The asymmetric gait toenail unit sign

Area of Science:

• Podiatry
• Dermatology
• Orthopedics

Background:

• Toenail abnormalities can be misdiagnosed as onychomycosis.
• Asymmetric walking gait can be linked to underlying skeletal issues.
• Differentiating fungal infections from mechanical causes is crucial for proper diagnosis and treatment.

Purpose of the Study:

• To identify toenail changes caused by shoe friction that mimic onychomycosis.
• To investigate skeletal causes of asymmetric walking gait and associated nail abnormalities.
• To differentiate between fungal nail infections and mechanically induced nail dystrophies.

Main Methods:

• Clinical examination of toenail units and feet.
• X-ray imaging to assess skeletal structures affecting foot biodynamics.
• Review of 49 dermatophyte-negative patients with toenail and skeletal abnormalities.

Main Results:

• Shoe friction causes toenail changes (e.g., onycholysis, nail bed keratosis) that resemble distal subungual onychomycosis.
• Skeletal abnormalities were identified as a common cause of asymmetric gait and related nail deformities.
• Familial and age-related skeletal findings were noted to exacerbate these conditions.

Conclusions:

• Toenail changes resembling onychomycosis can result from shoe friction and are fungus-negative.
• Asymmetric gait syndrome is associated with specific skeletal abnormalities and distinct nail presentations.
• Not all nail dystrophies are indicative of fungal infection; mechanical and skeletal factors play a significant role.