onychogryphosis onychogryphosis onychogryphosis is a hypertrophy that may produce nails resembling claws or a ram's horn. onychogryposisother namesonychogryposis or ram's horn nailsspecialtydermatology causes onychogryphosis demonstrating the characteristic ram's horn appearance ram's horn toenails on a bedridden patientonychogryphosis may be caused by trauma or peripheral vascular disease, but most often secondary to self-neglect and failure to cut the nails for extended periods of time.: 783–4 this condition is most commonly seen in the elderly. treatment some recommend avulsion of the nail plate with surgical destruction of the nail matrix with phenol or the carbon dioxide laser, if the blood supply is adequate.: 783–4 : 659 epidemiology severe congenital onychogryphosis affecting all twenty nailbeds has been recorded in two families who exhibit the dominant allele for a certain gene. congenital onychogryphosis of the fifth toe (the baby, little, pinky or small toe) is fairly common, but asymptomatic and seldom brought to the attention of medical professionals. rather, it is brought to the attention of manicurists who routinely file the clawed toenail flat.