Leukonychia case

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I have seen a 65 y.o. lady who was curious to find out why her hallux nails have started to exhibit a patchy white pattern. On examination I have noted that there was no onycholysis, but the white patches were actually the nail itself on both hallux. I did notice that even the 5th toe nails (bilateral) were completely white. Nails did not exhibit any crumbling but nail texture was as a healthy nail. Please note that the nail condition only exhibited on the hallux of both feet and the 5th toe nails.

I would appreciate your inputs. cheers
daV

 

Re: Leukonychia ??

Hi David,

My guess from the above comment is that the shoes are possibly too narrow and/or tight... There seems to be a great number of post-menopausal females wearing poorly fitted shoes, which I think is due to their feet "spreading" with age/hormonal change, and them not adapting their shoe size accordingly...

Regards

Donna

 

Re: Leukonychia ??

I agree with Donna in that the whitening of only the halluces and 5th digits could indicate shoe trauma to the nail matrices. If the lady is an ongoing patient you may have noticed the whitening progress slowly, as whitening caused by matrix trauma half way up the nail would indicate the pressure has been there for at least 6-9months.

Matt Kimball.

 

Re: Leukonychia ??

G'Day

Could be an onychomycosis developing from the sulci of both hallux nails after being cleaned out with an infected instrument, developing form the bottom up? Also could be a paronychia with pockets of exudate under the nails, or could be blisters forming under the nails from footwear pressure. Will agree that involvement of both 1st and 5th nails suggest could be footwear. Perhaps after a particurly long/busy day in a particular pair of shoes?

Good luck!

 

Re: Leukonychia ??

I saw a patient yesterday afternoon who brought her shoes in for her orthotic fit appointment, who had only 1 of the 5 pairs of lace-up walking shoes (all quite expensive and from a store advertising multiple width fittings) that were the correct length and width for her feet!

She complained that most of these shoes were too uncomfortable to wear. The most comfortable pair (in her opinion) was an Ecco walking shoe that was much too narrow and only 1mm longer than her foot, I wonder if some patients become accustomed to wearing shoes that are too tight and therefore eventually feel that this is "normal" for them... After much discussion and education on footwear fitting, the patient now has a much better idea of how her shoes should fit.

We find that using the shoe's removable insole as an easy guide to foot sizing is invaluable, and advise our patients to use this as a sizing guide when buying shoes... You usually see the bottom jaw drop when you take the insoles out of the patient's existing shoes and show them that their shoes are actually too small! :empathy:

 

Re: Leukonychia ??

I agree, simple and effective. I often do this along with verbal advice on footwear. Some patients just need visual aid to get the message.

With regard to the leukonychia, I would agree with the others that ill fitting footwear is probably the main cause. Does she have history of acrocyanosis? This can sometimes accompany leukonychia, although usually with lysis. However the majority of leukonychia, affecting all nails, is asymptomatic.

Cheers,
Bel

 

An Idiopathic Leukonychia Totalis and Leukonychia Partialis Case Report and Review of the Literature
Canavan T. · Tosti A. · Mallory H. · McKay K. · Cantrell W. · Elewski B.
Skin Appendage Disord 2015;1:38-42