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This is a really worn, tired and old theme for a press release that the APMA and other organizations seem to roll out on a regular basis ---- HOWEVER, the media do seem to pick it up.
How about clubbing of nails,Beau's lines,Mee's lines,etc.Toenail involvement can be an indicator of liver,kidney or circulatory problems.
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Hi John,
Yep it had crossed my mind! Silly me I thought the US. had something new in mind! Circulation and the nail shape seems to be the in thing up here, it must be darkest winter, the cause? Everybody I'm coming across seem run down to date!
Recently patient presented complaining of mildly tender R4 nail. Pt reports the nail needs cutting every 2/52, recently GP became concern re: shape. Pt reports has been this way since he was born. On examinatin clubbing of the R4 nail with significant hyperplasia of the nail bed extending deep into the distal end of the digit. Mild clubbing was also noted at the L4 nail. No history of bowel, pulmonary, or heat disease reported.
For my mind this is a congenital hyperplasia of the L/R4 nail bed. Have advised patient on nail care, and will keep a close eye on things.
Any ideas as to cause? any need for further intervention other than monitoring and patient education?
I've previosuly seen a patient, 10 year old boy with clubbing of both second toe nails, but there was also a congenital plantarflexed DIPJ on these digits (mother has similar deformity). The nail was causing a lot of discomfort - and due to the age of the patient, and conservative treatment (debridement of the distal portion of the nail to reduce pressure on the toe) helping only mildly, I advised the patient to seek surgical opinion for correction of the deformity. I would say this is completely different to your patient though , as there is no mention of boney deformity in your post - so I guess this doesn't really help
I have seen patients with PIPJ deformity of the second toe, especially women, where the second toe is longer than the 1st toe...which leads me to believe that poorly fitting footwear could be the cause in some of these people. I am under the impression that a lot of people still fit the length of their shoes to the big toe, regardless of whether this is the longest toe or not. What do you think of this phenomenon?
Toenails - Barometer of Health!
, as there is no mention of boney deformity in your post - so I guess this doesn't really help 
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