Onychogryphosis (Ram’s Horn Nails)

Medically reviewed by William Morrison, MD on October 31, 2017Written by Taylor Griffith

What are ram’s horn nails?

Onychogryphosis is a nail disease that causes one side of the nail to grow faster than the other. The nickname for this disease is ram’s horn nails because the nails are thick and curvy, like horns or claws. Onychogryphosis mostly affects the toes — specifically the big toes.

If you have onychogryphosis, your nails will look:

  • yellow or brown
  • unusually thick
  • long (extending beyond the toe)
  • curved

Ram’s horn nails can develop at a variety of ages depending on the underlying cause. It can be especially problematic for young adults and older adults. If you think you may have onychogryphosis, you should seek treatment. The condition will get worse with time, and can also cause:

  • ingrown nails
  • pain
  • infection
  • inability to pursue physical activities like sports or physically active careers
  • time away from work

6 causes of onychogryphosis

1. Foot trauma

Repeatedly hurting your feet — or minor foot trauma — can damage the toes and nail plates, eventually leading to onychogryphosis. For example, wearing shoes that are too small for you every day can cause foot trauma. Onychogryphosis can also develop if you have a condition like hammer toe. Treatment can be as simple as wearing shoes that are the correct size. You can also use splints and pads to train the toes and nails to grow normally.

2. Fungal infection

Onychomycosis is a fungal infection that causes the nails to become thick, crinkly, and brittle. This infection mostly affects toenails but can also impact fingernails.

Research shows up to 50 percent of Onychomycosis cases complicate or may lead to ram’s horn nails. Doctors diagnose Onychomycosis by examining skin tissue that is swabbed or scraped from under an affected nail. Oral and topical antibiotics can be used to treat fungal infections.

3. Psoriasis

Psoriasis is a fairly common autoimmune disease that causes the body to produce extra skin cells. These extra cells build up and form red, dry, scaly patches of skin. These skin growths can also affect the nails.

Roughly half of people with psoriasis experience nail changes. Roughly one third of people with nail psoriasis have onychomycosis.

Steroid injections in the nail beds may be able to treat these growths. Taking antifungal medication may also help. If these treatments don’t work, you may need surgery.

4. Peripheral vascular disease

Peripheral vascular disease, also called peripheral artery disease (PAD), causes the arteries in your legs to build up with plaque. This reduces blood flow to your legs and feet. Without proper blood flow, you may notice sores on your legs or feet, and slow or unusual nail growth. If left untreated, PAD can lead to onychogryphosis. Smoking is a main risk factor for developing PAD. Treatment options include lifestyle changes, medication, and surgery to clear the artery of plaque.

5. Ichthyosis

Ichthyosis is a rare skin condition that prohibits the body from shedding dead skin cells. A common symptom of this genetic condition is thickened or deformed nails, which can turn into onychogryphosis in some cases. Ichthyosis is normally diagnosed at birth when a baby is born with collodion membrane on their skin. Topical creams and oral retinoids are the most common treatment methods. If onychogryphosis develops, surgery may be necessary.

6. Tuberous sclerosis complex

Tuberous sclerosis complex (TSC) is a rare genetic disease that causes benign tumors to grow throughout the body. TSC is typically diagnosed because of the skin problems associated with it, including nail deformities. While the nail deformities go away in some cases, they may get worse over time, turning into ram’s horn nails. Other symptoms of TSC include cognitive impairment, autism, and seizures. Treatment for ram’s horn nails associated with TSC is surgery.

Onychogryphosis treatment

Surgery is the only treatment option for onychogryphosis. The type and frequency of the surgery, however, is based on the cause of ram’s horn nails. If the condition is genetic, you may have to get the same surgery multiple times as the nails grow back. To permanently solve this problem, your doctor may suggest removing the affected nail plate.

If the cause is less severe, such as foot trauma or infection, your doctor will perform surgery to correct the problem. They will then teach you how to properly cut your nails and care for your feet so the problem does not happen again. Nails should be clipped straight across rather than curved to avoid ingrown nails. You should also wear clean cotton socks that can absorb moisture and help prevent fungal infections.

Additional treatment methods may be used to address the underlying cause of ram’s horn nails to prevent the condition from developing.

Managing ram’s horn nails

Not only are ram’s horn nails unsightly, they are also painful and can severely impact your quality of life.

While it’s not always possible to prevent onychogryphosis, here are a few simple things you can do to promote nail health:

  • keep nails trimmed short
  • cut nails so they are straight, rather than curved at the edges
  • wear shoes that fit and have enough room in the toe box
  • wear cotton socks that absorb moisture
  • change socks regularly
  • wear gloves when handling chemicals

You can manage ram’s horn nails by:

  • wearing adapted shoes
  • regularly visiting a podiatrist
  • using a wheelchair or motorized scooter to keep pressure off your feet
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