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Imaging Quiz Question

Running-Related Toenail Abnormality

Brian B. Adams, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 27 - NO. 13 - DECEMBER 1999


A 33-year-old man presented with a keratotic plaque on his distal second toe. The plaque had been present for several months, and he also reported nail discoloration. The patient had no other related complaints. There was no family history of a similar eruption.

On physical examination, the patient had a scaling, skin-colored plaque that extended from his hyponychium to the distal portion of his second toe (figure 1). In addition, proximal transverse ridging and brown-black discoloration were present. There was evidence of onycholysis, but not of subungual hyperkeratosis.

[Figure 1]

After further questioning, the patient said that the plaque and nail discoloration had appeared soon after he had begun marathon training.

Based on this information, what is your diagnosis?

Dr Adams is an assistant professor in the department of dermatology at the University of Cincinnati College of Medicine and chief of dermatology at the Veterans Administration Medical Center in Cincinnati. Address correspondence to Brian B. Adams, MD, Dept of Dermatology, University of Cincinnati, College of Medicine, Box 670592, Cincinnati, OH 45267-0592; e-mail to: [email protected].


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