Traumatic onycholysis refers to the lifting of the distal nail plate from the nail bed due to various environmental factors that introduce overt or subtle mechanical force. It is speculated that the nail plate maintains connection to the nail bed via the distal onychocorneal band. Interruption of this band or from other supportive structures (lateral nail folds, hyponychium) via traumatic shearing, blunt force (slamming finger in door), or microtrauma (rubbing against shoe material) initiates the development of onycholysis [1, 2]. Traumatic onycholysis is exacerbated via continued exposure to trauma from microtraumas, including ill-fitting shoes, frequent typing, manual labor, or child care, and is made worse with long nails, frequent under-nail cleaning by patients, harsh manicure techniques, or exposure to water work or caustic irritants [3–5]. With prolonged exposure to these environmental factors over 6 weeks, the nail bed may undergo keratinization making nail plate reattachment unlikely [2, 3]. Further, superimposed infection (fungal, bacterial, or viral) may impede proper nail attachment/re-growth [3, 4]. Traumatic toenail onycholysis from ill-fitting/narrow toe-box shoes is sometimes categorized into a group of clinical findings referred to as asymmetric gait nail unit signs [6]. Onycholysis can be staged from I to V based on the range of separation with stages I–III representing various measures of onycholysis measured via the distal nail plate from hyponychium, to stage IV with total onycholysis, and stage V with full destruction and subsequent cornification of the nail bed [3].