What Is Onychogryphosis?

Medically Reviewed by Debra Jaliman, MD on May 09, 2023
4 min read

Onychogryphosis — also known as ram’s horn nails — is a condition mostly affecting the big toenail, in which one set of toenails grows substantially more, and faster, than the other. The nails often become yellow, hardened, and take on a veined, curvy appearance that reminds many people of a ram’s horns — hence the name. It can develop at any stage of life, but older adults are especially susceptible to it.

Nails are predominantly made up of a protein called keratin, which ordinarily accumulates one layer after the next in mostly symmetric order in both your hands and feet. When something in your body is out of sync, your finger and toenails often provide some early warning signs. For example:

Such being the case, it’s important to keep a close eye on your nails and watch for any unusual changes or growths. Simply put, onychogryphosis doesn’t just develop from one day to the next. Many cases result from years of inadequate personal care.

Ram’s horn nails are especially prominent in older people, particularly those who live with or have had:

It can also be caused by trauma to the feet, caused by either foot injury or wearing poorly fitting shoes. While onychogryphosis is most common in the big toe, it can affect any of the toes on either foot.

Although some are inclined to think of toenail fungus as purely an aesthetic problem, the truth is that toenail fungus has many serious complications if left untreated for too long. Onychogryphosis may well be one of them.

As many as 50% of those living with onychogryphosis reported having had toenail fungus for many years before their condition developed into onychogryphosis. That doesn’t mean toenail fungus was the cause, but there’s very likely a correlation between the two.

Onychogryphosis is not merely a benign or cosmetic condition. Left untreated and unmanaged, it can seriously impact your quality of life over time and lead to other health problems as well. The long, abnormal nail growths often twist and turn in various directions, even growing back into the skin, causing ingrown toenails, or putting pressure on the skin and causing inflammatory conditions like paronychia.

In addition, onychogryphosis often has a pronounced impact on the quality of life of the people who live with it. Depending on how far the condition has developed, it can be very hard for the person to wear ordinary socks and shoes. People with onychogryphosis may lose their mobility and independence, becoming more and more reliant on others to help them as time goes by. It can also impact their self-esteem and increase their feelings of social isolation.

Once it develops, onychogryphosis is only treatable through surgery. This can be a delicate procedure since many of those with onychogryphosis have vascular and circulatory problems in their legs and feet. Surgically removing the entire nail bed is the most common treatment, but there are promising innovations in treatment that may make this process easier in the future.

For example, a 2018 study reported a surgery for onychogryphosis in which the entire toenail was simply repaired, not removed. The doctors used a combination of fungal treatments and precise cutting to reshape the nails and eliminate the “hornlike” growth pattern. They achieved satisfactory results in 90% of cases in which the new method was used.

Everyone should try to take care of their feet as much as they can, but onychogryphosis particularly affects older adults who already have problems with their feet, legs, and circulation. The following methods for preventing nail problems like onychogryphosis will work for anyone, but people who already have conditions like fungus or diabetes ought to be especially diligent:

Keep a close eye on your feet. Don’t ignore fungus on your toenails. Any cuts, spots, or unusual growths on your feet should be meticulously cared for. Consult a doctor if you’re not sure what to do.

Trim your nails after washing. Washing has the two-fold benefit of keeping your feet clean and making rough toenails easier to cut. Just avoid cutting into the corner of the nail.

Don’t be afraid of activity. Poor circulation in the feet can cause many complications, including onychogryphosis. Getting regular exercise, even just in the form of a daily walk, can greatly benefit your overall foot health.