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Association between Onychogryphosis and Lower Extremity Complications: A Multicenter Cohort Study Using TriNetX
Natalia Chalupczak1, Shari R Lipner2
1Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, IL, USA.
Skin Appendage Disorders
|June 29, 2026
Summary
Onychogryphosis significantly increases the 5-year risk of lower extremity complications like amputation and ulcers. Early identification of this nail condition warrants focused foot assessment and risk screening for high-risk individuals.
Area of Science:
- Podiatry
- Vascular Medicine
- Dermatology
Background:
- Onychogryphosis, a nail disorder, is linked to chronic foot issues and vascular disease.
- The association between onychogryphosis and the risk of lower extremity complications requires further investigation.
Purpose of the Study:
- To evaluate the 5-year risk of lower extremity complications in patients with onychogryphosis.
- To determine if onychogryphosis is an independent risk factor for these complications.
Main Methods:
- A large cohort of patients with onychogryphosis was propensity score matched (1:1) to controls.
- Cox proportional hazards models were used to estimate 5-year hazard ratios (HRs) for complications.
- Subgroup analyses were conducted for patients with type II diabetes and peripheral artery disease (PAD).
Main Results:
- Onychogryphosis was associated with a significantly increased 5-year risk of foot/toe amputation (HR 2.798), ulcer (HR 2.108), cellulitis (HR 1.743), osteomyelitis (HR 1.673), and gangrene (HR 1.485).
- These associations remained significant in subgroup analyses including patients with type II diabetes and PAD.
Conclusions:
- Onychogryphosis is linked to a substantially increased risk of major lower extremity complications.
- Prompt lower extremity assessment and risk screening are recommended for patients with onychogryphosis, particularly those with diabetes or PAD.
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