Approach Considerations
Early recognition can help avoid the need for additional tests and unnecessary treatment. Radiologic studies can help characterize underlying bone abnormalities. Clinical evaluation can help determine if underlying vascular abnormalities may be contributing to the disorder. Family members should be evaluated to help identify a familial basis in some kindreds.
Laboratory Studies
No laboratory studies are necessary in onychodystrophy of the index finger (COIF).
Imaging Studies
Radiographs of the affected digits often reveal a narrow distal phalanx on anteroposterior view, a Y-shaped bifurcation on lateral view, or both, as in the images below.
Radiographs can assist in the diagnosis of congenital onychodystrophy of the index finger, but the findings typically do not affect treatment unless associated surgically correctable anomalies are found.
Y-shaped bifurcation of the distal phalanx of the left index finger in the lateral view. Courtesy of Veterans Administration Puget Sound Health Care System.
Y-shaped bifurcation of the distal phalanx of the right index finger in the lateral view. Courtesy of Veterans Administration Puget Sound Health Care System.
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Micronychia of the left index finger and malalignment of the nail of the middle finger. Courtesy of Veterans Administration Puget Sound Health Care System.
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Y-shaped bifurcation of the distal phalanx of the left index finger in the lateral view. Courtesy of Veterans Administration Puget Sound Health Care System.
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Y-shaped bifurcation of the distal phalanx of the right index finger in the lateral view. Courtesy of Veterans Administration Puget Sound Health Care System.
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This infant illustrates the typical presentation of congenital onychodysplasia of the index finger (COIF). Examination of the right index finger reveals micronychia. The changes of the left index finger approach anonychia except for the presence of a small amount of dystrophic nail. Courtesy of Dr. Ilene Rothman.
