Congenital onychogryphosis: Leaning Tower nail.

A 45-year-old man presented with a thickened and raised nail of his left fifth finger since birth. He was otherwise healthy. On examination, the nail of the left little finger was markedly thickened, hyperkeratotic, and situated at an angle of approximately 45 degrees to the long axis of the distal phalanx. There was prominent subungual hyperkeratosis. A diagnosis of congenital onychogryphosis of the little finger of idiopathic nature was considered. Visual analogy to the leaning tower of Pisa encouraged us to describe it as congenital leaning tower nail.