To the Editor.—
The reports of dystrophy of the great toenail by Vasily1 and Samman2,3 show exactly what we have termed "congenital malalignment of the big toe nail"4 because the longitudinal axis of the nail is laterally deviated. This condition quickly results in onychodystrophy after minor trauma to the free nail edge against either the shoe or against a small margin of heaped-up tissue in front of the nail. Transverse ridging develops over the entire surface of the nail plate and seems to follow the recurrent episodes of damage to the matrix so that even shedding of the nail may occur (Figure). This deformity can easily be repaired by a surgical procedure to the matrix, in which the nail plate and associated tissue are realigned. This treatment prevents later problems such as hemionychogryposis.
Baran R. Congenital Malalignment of the Big Toenail. Arch Dermatol. 1980;116(12):1346. doi:10.1001/archderm.1980.01640360020004