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Fig 3.-Twins aged 3 years. Great toenail of right foot is onychogryphotic and left great toenail is only malaligned. possess a mild variant of great toenail malalign¬ ment.These cases clearly demonstrate the genetic fac¬ tors in this condition. If the dystrophy were due to intrauterine positioning, both great toenails would be dystrophic for the nails would all be dystrophic rather than the curious combination of one onycho¬ gryphotic and one malaligned but otherwise normal nail. We believe that the dystrophy is due to the genetically determined malalignment of the toenails plus superimposed cumulative effects of postnatal trauma.

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