Congenital Malalignment of the Great Toenails: A Rare Familial Presentation in Adolescence

Congenital malalignment of the great toenail (CMGT) is a rare nail disorder characterized by lateral deviation of the nail plate due to malrotation of the nail matrix. We describe the case of a female adolescent with progressive nail discoloration, abnormal growth, and recurrent shedding of the great toenails. Similar findings were also observed in other family members, suggesting a hereditary predisposition. Fungal studies were negative. The patient was managed conservatively with protective footwear and regular trimming, while surgical matricectomy was declined. This case underscores the importance of distinguishing CMGT from onychomycosis and highlights the value of conservative management in the absence of severe symptoms.