Onychogryphosis, is a nail disorder characterised by thickening and yellowish brown discoloration. It is most commonly acquired, but may also be congenital or associated with some genodermatoses. A case of a 45-year old female with nail deformity consequent upon an 8-year history of not cutting her nails and rarely leaving home. Examination revealed thickened, brown, twisted toenails with transverse ridges along their length. The great toenails were most severely affected, with the right measuring approximately 7 cm. She was diagnosed with onychogryphosis, the nails were cut and she was recommended psychiatric care, but became lost to followup. Onychogryphosis is a common nail disorder, which may be congenital or acquired. The congenital form is rarer and is often autosomal dominant. The therapy may be conservative or surgical. In this chapter a case of onychogryphosis is presented with a review of the disorder.