title: The asymmetric gait toenail unit sign.
abstract: The aim of this investigation was to resolve a diagnostic problem and report toenail unit changes attributable to shoe friction that resemble onychomycosis, but that are fungus-negative, and identify common skeletal causes in patients with an asymmetric walking gait. X-ray and clinical feet inspections were performed to evaluate skeletal components that change normal foot biodynamics. Forty-nine patients, all dermatophyte-negative, were reviewed. All patients were those seen in our private practice who demonstrated skeletal and toenail unit abnormalities such as onycholysis, nail bed keratosis resembling distal subungual onychomycosis, nail plate surface abnormalities, distal toe skin keratosis, a diagnostic nail plate shape, as well as several skeletal abnormalities. The clinical abnormalities of the asymmetric gait syndrome include onycholysis, nail bed keratosis, nail plate surface abnormalities, and a diagnostic nail plate shape. By the patient's history, the skeletal findings that were present worsened with age and, in many patients, they were familial. Onychomycosis does not lead to an asymmetric gait nail problem, asymmetric gait toenail does not favor dermatophyte infection, and not all nail dystrophies are the result of an asymmetric walking gait.
authors.affiliation: Department of Dermatology, Mount Sinai Medical Center, Miami Beach, FL 33140, USA. nardozaias@aol.com
authors.forename: Nardo
authors.initials: N
authors.lastname: Zaias
authors.forename: Gerbert
authors.initials: G
authors.lastname: Rebell
authors.forename: German
authors.initials: G
authors.lastname: Casal
authors.forename: Jason
authors.initials: J
authors.lastname: Appel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003883:Arthrodermataceae / Q000302:isolation & purification; D001696:Biomechanical Phenomena; D005260:Female; D005528:Foot / Q000502:physiology; D005533:Foot Dermatoses / Q000175:diagnosis; D005684:Gait; D006801:Humans; D008297:Male; D008875:Middle Aged; D009262:Nails / Q000382:microbiology / Q000473:pathology; D014009:Onychomycosis / Q000175:diagnosis; D055815:Young Adult