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© 2005 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 24:1085-1089 • 0278-4297

Venous Insufficiency in Patients With Toenail Onychomycosis

Mustafa Kulac, MD, Murat Acar, MD, Semsettin Karaca, MD, Zafer Cetinkaya, MD, Ramazan Albayrak, MD, Alpay Haktanir, MD and Reha Demirel, MD

Departments of Dermatology (M.K., S.K.), Radiology (M.A., R.A., A.H.), Microbiology (Z.C.), and Public Health (R.D.), Afyon Kocatepe University, Faculty of Medicine, Afyon, Turkey.

Address correspondence to Murat Acar, MD, Department of Radiology, Afyon Kocatepe University, Faculty of Medicine, Kirmizi Hastane, 03200 Afyon, Turkey. E-mail: drmacar{at}hotmail.com

Objective. Onychomycosis is a common fungal infection of the toenails and can originate secondary to vascular abnormalities. The aim of this study was to evaluate the relationship between onychomycosis and venous insufficiency. Methods. Forty-two patients with onychomycosis and 39 healthy control subjects who had normal toenails were enrolled in the study. Doppler examinations were performed with a commercially available scanner and a 7.5-MHz linear probe. Major superficial and deep veins of the lower limb, including long and short saphenous, femoral, and popliteal veins, were examined. Venous insufficiency was assessed with the Valsalva test. With the Doppler examination, retrograde flow of more than 1 second was accepted as venous insufficiency. Results. Venous insufficiency was detected more frequently in patients with onychomycosis than in the control group (15 [35.7%] of 42 and 6 [15.4%] of 39, respectively; P = .037). Reflux was bilateral in 4 (26.7%) of 15 patients with onychomycosis, and in those 4 patients the onychomycosis was also bilateral. In 7 (46.7%) of 15 patients, onychomycosis and venous insufficiency were detected ipsilaterally, whereas there were no onychopathic features contralaterally. Although unilateral insufficiency was present in 4 (26.7%) of 15 patients, these patients had bilateral onychomycosis. Conclusions. We found a significant relationship between onychomycosis and venous insufficiency; therefore, we recommend a routine venous Doppler examination for patients with onychomycosis to diagnose or rule out venous insufficiency.

Key Words: Doppler ultrasonography • onychomycosis • venous insufficiency

Abbreviations: CDU, color Doppler ultrasonography • CVI, chronic venous insufficiency

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