Clubbing is changes in the areas under and around the toenails and fingernails that occur with some disorders. The nails may also show changes. Clubbing may result from chronic low blood-oxygen levels. This can be seen with cystic fibrosis, congenital cyanotic heart disease, and several other diseases.
It may be that your toes and fingers are clubbed and there isn't a disease causing the clubbing. If that's true, the clubbing isn't harmful. However, in most cases, your healthcare providers will check to make sure that there's no other disease involved.
Often, there is no pain with clubbing. The condition affects both sides. The enlargement of the fingertips or toes occurs over time, and may not be noticed by the individual. In clubbing, the layer of cells under the nails becomes soft.
Clubbing of toes but not fingers suggests coarctation of the aorta. Unidigital clubbing is seen following median nerve injury and, rarely, with sarcoidosis. Recurrent clubbing may occur during pregnancy in otherwise healthy women.
Fingernail clubbing has been found in most patients with kwashiorkor, or protein malnutrition (SOR: C, one cross-sectional study).
Clubbing of nails is associated with the cretinism caused by iodine deficiency. Hapalonychia (soft nails) has been associated with deficiencies of vitamins A and D among other causes. Longitudinal melanonychia of the nail plate has been reported in vitamin D deficiency.
Treating the underlying cause of clubbing can reverse this condition if the underlying condition also improves. However, when chronic, malignant, or persistent conditions cause clubbing, the condition is often long-term. In some cases, in particular congenital cases, corrective surgery may be necessary.
Although clubbing itself is harmless and doesn't require treatment, it is often associated with health conditions that can worsen without treatment.
Very pale nails
Healthy nails are generally pink. Very pale nails may indicate illnesses, such as anemia, congestive heart failure or liver disease.
Clubbing is present in one of five stages: No visible clubbing - Fluctuation (increased ballotability) and softening of the nail bed only. No visible changes of nails. Mild clubbing - Loss of the normal <165° angle (Lovibond angle) between the nailbed and the fold (cuticula).
Clubbing may be present as an hereditary anomaly in selected families. When this anomaly is observed in a presumably healthy person, inquiry into the duration of the abnormality and the possible familial distribution may be rewarding.
At this stage, finger develops a clubbed appearance. Finally, the nail and peri-ungual skin appear shiny and nail develops longitudinal ridging. This whole process usually takes years but in certain conditions, clubbing may develop sub-acutely (e.g. lung abscess, empyema thorasis).
Clubfoot is caused by a shortened Achilles tendon, which causes the foot to turn in and under. Clubfoot is twice as common in boys. Treatment is necessary to correct clubfoot and is usually done in two phases — casting and bracing.
In clubbing, there is widening of the AP and lateral diameter of terminal portion of fingers and toes giving the appearance of clubbing. The angle between the nail and skin is greater than 180o. The periungual skin is stretched and shiny. There is fluctuation of the nail bed.
Finger clubbing can be a sign of a number of underlying health conditions, particularly of the lungs or heart. This includes cancers such as lung cancer and mesothelioma. But finger clubbing can also be found in some people with thyroid problems or other conditions such as ulcerative colitis and Crohn's disease.
Nail clubbing is associated with mesothelioma, which is a type of malignancy of the lungs, abdomen, or heart caused by inhalation of asbestos fibers. Lung metastases from extrapulmonary carcinomas are rarely associated with nail clubbing.
In clubbing, the angle flattens out and increases as the severity of the clubbing increases. If the angle is greater than 180°, definitive clubbing exists. An angle between 160-180° falls in a gray area and may indicate early stages of clubbing or a pseudoclubbing phenomenon.
Those aged 25 to 44 were the most likely to attend a pub, bar or club, with 59.3 percent of respondents in that age category visiting such an establishment.
There are several causes of acquired nail clubbing which include infectious, neoplastic, inflammatory, and vascular diseases. [2] Isolated nail clubbing can be a benign hereditary condition but given the multiple associated conditions underlying etiology should be ruled out.
From nostalgia nights to dance festivals, older clubbers – such as Mick Jagger, 76, spotted at gay club night Horse Meat Disco earlier this year – are finding their second wind. Typically, clubbing loses its appeal in our early 30s; 31 is the age at which most give up, according to a 2017 survey.
Early findings suggest that cirrhosis-caused nail clubbing is not a result of bone disorders but a consequence of an increase in peripheral blood flow with dilation of the veins in the finger.
Vitamin D ensures healthy nails and reduces the risk of nail peeling and chipping, which can often be caused by nutritional deficiencies.
2 Nail changes in vitamin B12 deficiency present as hyperpigmentation of nails like bluish discoloration of nails, blue-black pigmentation with dark longitudinal streaks, and longitudinal and reticulate darkened streaks. The nail pigmentation associated with B12 deficiency is more frequent in patients with dark skin.