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The reason why the lateral distal corner of the hallux is the most likely for o/lysis of all the dig

Discussion in 'General Issues and Discussion Forum' started by markjohconley, May 10, 2013.

  1. markjohconley

    markjohconley Well-Known Member

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    It has been suggested pressure from the 2nd digit? any others, thanks, mark
  2. Generally the hallux digits, are the first to be damaged, due to shoe wear, however, if there is a deviation towards the 2nd digit, then that also might be the reason for this too !

  3. markjohconley

    markjohconley Well-Known Member

    Thanks Caroline, any other thoughts out there in the podiatry world?
  4. Leigh

    Leigh Member


    J Cutan Med Surg. 1998 Jul;3(1):40-2.
    Onycholysis and thyroid disease: report of three cases.
    Nakatsui T, Lin AN.
    Division of Dermatology and Cutaneous Sciences, University of Alberta, Edmonton, Canada.
    Onycholysis is a common disorder with many causes. It is known to be associated with thyroid disease (especially hyperthyroidism), but physicians probably do not routinely screen for underlying thyroid disease.
    To study the association of onycholysis and thyroid disease.
    We report three patients with onycholysis who were investigated for thyroid disease. Results: In two patients, onycholysis was the presenting sign of previously undiagnosed hypothyroidism, whereas the third developed onycholysis while undergoing therapy for hypothyroidism.
    These three cases appear to suggest that patients with unexplained onycholysis should be screened for asymptomatic thyroid disease.
  5. Elizabeth Humble-Thomas

    Elizabeth Humble-Thomas Active Member

    If you cup the hallux in your hand to imitate the shape of a shoe, you will find in these cases that the 2nd toe, often a long 2nd, will over-lie the lateral edge of the nail. The constant tapping of this toe whilst walking gradually lifts the nail corner form the nail bed.
    Best solution I find is small silicone inter digital wedge, preferably bland Rose silicone, slightly flattened on the dorsum to keep it in place., and footwear advice.
  6. blinda

    blinda MVP

    Copied from another thread;

    I replied;

  7. efuller

    efuller MVP

    Point of clarification. Are you talking about lateral to the midline of the body or midline of the foot?

    Mechanically, I can make the case for the tibial boarder of the hallux nail. Valgus rotation with HAV. Limited range of motion of the 1st mpj after heel off will cause a lot of load at the distal hallux. Gait with a medial "roll off" in conjuction with limited dorsiflexion will also tend put quite a bit of load at the distal, tibial, aspect of the toe.

  8. Leah Claydon

    Leah Claydon Active Member

    My theory: lysis of the nail on the fib/lat distal edge of hallux nail bed is often caused by compression of the 2nd toe causing ischaemia of the nailbed (ie blanching of the nail bed) and ensuing detachment of the proximal lamination of the nail plate.

    My treatment for this is, cutting back of the affected part of the nail to the attached distal part, interdigital wedge to 3/4 length of toe to prevent any contact with the hallux nail. This obviously with treatment of aggravating biomechanical factors and footwear advice.

    I find the nail bed usually reforms naturally as the nail grows up if the compression is alleviated. Da-nah!
  9. markjohconley

    markjohconley Well-Known Member

    Goodaye Eric, definitely the fibular side, closest to the 2nd digit, thanks, mark
  10. markjohconley

    markjohconley Well-Known Member


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