Patient history: A 67-year-old man presented with a 30-year history of severe thickening, curving, and yellow discoloration of his left great toenail. He stated that the nail broke off midway and regrew every six months. It had become more painful recently and was impinging on his second toe, making it difficult to walk and put on socks. There is no history of trauma, tinea pedis or family history of onychomycosis. Physical examination was notable for thickening and lateral deviation of the left first toenail.
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