Toenail Examination Reveals Unmet Care Needs

In Reply

We thank Dr Perry for sharing the tragic story about the recent death of her patient’s grandson. The story was elicited after Dr Perry noticed the patient’s long toenails; the grandson had been the one to help with the intimate activity of toenail care.

The intention in sharing our own patient’s story in our article¹ was to highlight that the simple physical examination finding of long toenails can provide an opportunity for the clinician to ask important questions about personal care. Long and uncared for toenails can point to problems with dexterity, mobility, vision, cognition or mood, or, as illustrated by Dr Perry’s patient, the loss of a caregiver.

Dr Perry’s attention to this detail of her patient’s examination, and curiosity as to why the toenails were long, enabled her to connect her patient with the support and resources she needed to weather the loss of her loved one. Our hope is that by encouraging clinicians to seek out this often-concealed part of the examination, additional opportunities for difficult conversations and tailored treatments may emerge.