A 51-year-old male patient was referred from the stroke unit to dermatological examination because of skin and nail disease of the affected leg. The patient was as long-time smoker and had several risk factors for stroke. On examination we observed scaling on the affects foot and lower leg without erythema or pruritus. The great toe showed a vertical growth of a thickened, dystrophic nail plate. The nail bed was miniaturized. Because of gait problems associated with the stroke the diagnosis of an asymmetric gait nail unit syndrome (AGNUS) was confirmed. This is the result of asymmetric shoe pressure on the toes and foot caused by uneven flat feet that affect the gait. The pressure produces clinical changes in the toenails and can also affect the nail bed.