Pitted keratolysis is a superficial bacterial skin condition that primarily affects the soles of the feet, though it can occasionally appear on the palms. It is characterized by small, crater-like pits in the thickened skin of the foot, accompanied by a distinctive and often pungent odor. While the condition is not dangerous and rarely causes serious medical complications, it can be a source of significant embarrassment and discomfort for those affected, particularly athletes, military personnel, and anyone whose feet are regularly exposed to warm, damp conditions. Understanding the treatment of pitted keratolysis requires first understanding its cause, since effective management depends on addressing both the bacterial infection itself and the environmental conditions that allow it to flourish.

Understanding the Underlying Cause

Pitted keratolysis, also known as ringed keratolysis, is caused by a range of bacterial species, with the most common culprits being Corynebacteria, Dermatophilus congolensis, Kytococcus sedentarius, Actinomyces, and Streptomyces. These bacteria are not inherently dangerous; they are often present on the skin in small numbers without causing any problems. The trouble begins when feet are kept in warm, moist conditions for extended periods, such as inside sweaty socks and shoes, or in occlusive footwear like boots or rubber-soled work shoes. Bacteria thrive under moist and warm conditions, and in this environment they multiply rapidly, producing enzymes that break down keratin, the structural protein that makes up the outer layer of skin. This breakdown of keratin is what produces the characteristic pits, and the bacterial byproducts are responsible for the foul smell that often accompanies the condition.

Because the appearance of pitted keratolysis is so distinctive, diagnosis is typically made through visual examination alone, without the need for laboratory testing. A clinician may, however, choose to take a skin scraping or swab if the diagnosis is uncertain or if other conditions, such as fungal infections, need to be ruled out.

Topical Antibiotic Therapy

The cornerstone of treatment for pitted keratolysis is topical antibiotic therapy aimed at eliminating the causative bacteria. Topical antibiotics are typically prescribed in a lotion form that is rubbed directly onto the affected skin, with common choices including clindamycin, erythromycin, and fusidic acid. These medications work by killing or inhibiting the growth of the bacteria responsible for the keratin breakdown, allowing the skin to heal and the odor to resolve.

Clindamycin in particular has been highlighted as effective against the Corynebacteria species frequently implicated in this condition. One notable development in treatment has been the combination of clindamycin with benzoyl peroxide in a single topical gel, which was studied as a novel therapeutic approach and found to be effective in clearing the infection while also providing antiseptic benefit. Mupirocin is sometimes reserved for cases involving bacterial strains that prove resistant to first-line agents. Most treatment courses involve applying the chosen antibiotic once or twice daily for a period of two to four weeks, though the exact duration can vary depending on the severity of the infection and the individual’s response to treatment.

In addition to prescription antibiotics, topical antiseptics such as benzoyl peroxide washes or gels are frequently used either alongside antibiotics or as an adjunct therapy. These agents help reduce the overall bacterial load on the skin and can shorten the time needed for symptoms to resolve.

Managing Moisture and Hyperhidrosis

Because excessive sweating, or hyperhidrosis, is the primary environmental driver of pitted keratolysis, controlling moisture is just as important as eliminating the bacteria themselves. Without addressing the underlying dampness, even a successful course of antibiotics may not prevent the condition from recurring.

Aluminum chloride-based antiperspirants are commonly recommended for this purpose. In some cases, reducing associated hyperhidrosis with the application of a roll-on antiperspirant, such as a 20% aluminum chloride solution, may be helpful in managing the condition. These products are applied to the soles of the feet, much as one would apply antiperspirant to the underarms, and work by temporarily blocking sweat glands.

For patients with more severe or treatment-resistant hyperhidrosis, more advanced interventions exist. Botulinum toxin injections, for example, have been used to treat plantar hyperhidrosis in conjunction with pitted keratolysis, reducing sweat production at the source and thereby removing the moist environment the bacteria need to thrive. While not a first-line treatment, this option may be considered for individuals whose sweating is severe enough to make standard treatments insufficient.

Hygiene and Lifestyle Modifications

Alongside medical treatment, a range of hygiene and lifestyle changes play a critical supporting role in both treating active infections and preventing recurrence. Patients are generally advised to wash their feet daily with antibacterial soap and to dry them thoroughly, paying particular attention to the spaces between the toes where moisture tends to linger.

Sock and footwear choices matter considerably. Moisture-wicking socks, particularly those made of wool rather than cotton, help draw sweat away from the skin rather than trapping it against the foot. Socks should be changed frequently throughout the day to prevent excessive moisture buildup, and one study recommended washing socks at a temperature of 60 degrees Celsius to kill any bacteria that may have transferred from the skin onto the fabric. Interestingly, research into sock materials has continued to evolve; a double-blind randomized controlled trial found that socks coated with zinc oxide nanoparticles were more effective than uncoated socks at reducing the development of pitted keratolysis and minimizing the associated odor.

Footwear itself should be chosen with breathability in mind, favoring shoes made from natural or moisture-permeable materials over tightly sealed synthetic options. Rotating dry insoles on a daily basis ensures that feet are never standing on persistently damp shoe interiors, and patients are typically advised to avoid sharing footwear with others to limit bacterial transmission.

Prognosis and Follow-Up

The good news for those affected by pitted keratolysis is that the condition responds well to appropriate treatment in the vast majority of cases. Pitted keratolysis can be treated successfully with adequate foot hygiene, topical antibiotics, and antiseptics, often resolving within a matter of weeks once treatment begins. However, because the underlying environmental triggers, namely sweat and occlusive footwear, are often a persistent part of a person’s lifestyle or occupation, recurrence is common if preventive habits are not maintained long-term.

For this reason, clinicians often emphasize that successful treatment is really a two-part process: clearing the active infection with antibiotics and antiseptics, and then maintaining the hygiene and moisture-control habits needed to prevent the bacteria from re-establishing themselves. Patients whose symptoms do not improve with standard therapy are generally advised to return for follow-up, as resistant cases may require alternative antibiotic regimens or additional interventions targeting hyperhidrosis.

Pitted keratolysis, while harmless in a medical sense, can meaningfully affect a person’s comfort and confidence. Effective treatment rests on three pillars: topical antibiotics to eliminate the causative bacteria, antiperspirant or other moisture-control measures to address the hyperhidrosis that allows the infection to take hold, and consistent foot hygiene practices to prevent recurrence. With this combined approach, most people can expect their symptoms to clear within weeks, provided they also commit to the lifestyle adjustments needed to keep their feet dry over the longer term.

Onychauxis is a common nail pathology characterised by a uniform thickening and hypertrophy of the nail plate, typically without significant structural deformity or lateral deviation. Often confused with onychogryphosis — a more severe condition involving pronounced curvature and distortion — onychauxis presents as a straightforward, though clinically significant, overgrowth of the nail. It most frequently affects the toenails, particularly the hallux (great toe), and is encountered regularly in podiatric practice. While the condition is not inherently dangerous, untreated onychauxis can lead to pain, subungual pressure, secondary infection, and considerable reduction in quality of life, particularly in elderly or immunocompromised populations. Understanding the aetiology, clinical presentation, and range of treatment options is essential for effective podiatric management.

Aetiology and Predisposing Factors

Onychauxis arises from a disruption in the normal mitotic activity of the nail matrix, which results in accelerated or abnormal nail cell production. This can be triggered by a variety of intrinsic and extrinsic factors. Repeated microtrauma — commonly caused by poorly fitting footwear, athletic activity, or prolonged pressure on the nail — is among the most frequent causes. The nail matrix, responding to chronic insult, overproduces keratinocytes, leading to progressive thickening of the nail plate over time.

Systemic conditions also play a significant aetiological role. Peripheral vascular disease, diabetes mellitus, and other conditions associated with poor circulation impair normal nail growth and repair mechanisms. Psoriasis is a notable dermatological cause, as it can affect the matrix and nail bed, producing thickened, dystrophic nails. Fungal infections, particularly onychomycosis caused by dermatophytes, are a major contributor to nail hypertrophy and must be differentiated from — or identified as co-existing with — onychauxis prior to formulating a treatment plan. Age-related changes in nail growth, circulation, and tissue elasticity mean that onychauxis is particularly prevalent in older adults.

Clinical Presentation and Assessment

Clinically, onychauxis presents as a uniformly thickened nail plate, often with a yellow, brown, or opaque discolouration. The nail surface may appear smooth or slightly ridged, and the nail is denser and harder than normal. Unlike onychogryphosis, the nail does not typically deviate laterally or assume a ram’s horn appearance. Patients may report difficulty cutting their nails, discomfort when wearing closed footwear, and occasionally pain at the nail margins due to pressure on the surrounding soft tissue.

A thorough clinical assessment is essential before initiating treatment. The clinician should evaluate neurovascular status, particularly in patients with diabetes or peripheral arterial disease, as compromised circulation affects healing and increases infection risk. The presence of fungal infection should be considered, and nail specimens may be sent for mycological analysis where onychomycosis is suspected. Assessment of footwear is also important, as ongoing mechanical trauma will undermine any intervention.

Conservative Treatment

The primary and most commonly employed treatment for onychauxis is conservative reduction of the nail plate through mechanical debridement. This is typically performed by a podiatrist using an electric burr or nail drill, which safely reduces the thickness of the nail without trauma to the underlying nail bed. The procedure is painless when performed correctly and results in immediate patient comfort. Following reduction, the nail is filed smooth to minimise pressure and friction within footwear.

Regular professional nail care is often necessary on an ongoing basis, as onychauxis tends to recur without addressing its underlying cause. Patients with systemic conditions or poor manual dexterity — particularly the elderly — benefit from scheduled podiatric appointments every six to ten weeks for maintenance.

Emollient therapy forms an important adjunct to mechanical reduction. Regular application of urea-based creams (typically 10–40% concentration) to the nail and surrounding tissue softens the nail plate, improves pliability, and facilitates easier debridement at subsequent appointments. Urea is keratolytic and helps to gradually reduce nail thickness when used consistently. Patient education around the daily application of emollients is an important component of a conservative management programme.

Footwear advice and orthotic intervention are valuable adjuncts. Patients should be guided towards footwear with a wide, deep toe box that reduces direct pressure on the nail. In cases where structural foot deformities — such as hallux valgus or digital contractures — contribute to nail trauma, orthotic devices or toe props may offload pressure and help prevent recurrence.

Treatment of Underlying Causes

Where onychomycosis is identified as a contributing or causative factor, antifungal therapy is indicated. Topical antifungals, such as amorolfine lacquer or ciclopirox, may be effective in mild to moderate cases, though their penetration of a thickened nail plate is limited. Systemic antifungals — most commonly terbinafine — are more effective for established fungal nail infection and are typically prescribed for twelve weeks for toenail involvement. Clinicians must assess suitability based on the patient’s medical history, medications, and liver function before initiating systemic therapy.

In patients with psoriatic nail disease, treatment of the underlying psoriasis — through topical corticosteroids, intralesional injections, or systemic biologics where indicated — may improve nail appearance and reduce hypertrophy. Dermatological referral may be appropriate in complex cases.

Surgical and Chemical Avulsion

In cases where onychauxis causes significant ongoing pain, recurring infections, or where conservative measures fail to provide adequate relief, more definitive intervention may be considered. Nail avulsion — either partial or total — involves the removal of the thickened nail plate under local anaesthesia. This provides immediate relief and allows inspection of the underlying nail bed for pathology.

Chemical matrixectomy using phenol (typically an 80–88% solution) is frequently performed following avulsion to permanently ablate all or part of the nail matrix, preventing regrowth. This is particularly appropriate when the nail is severely thickened, the patient cannot tolerate recurrent debridement, or where the nail serves no functional purpose. The procedure is well-tolerated and has a high success rate, though it requires careful wound management in the postoperative period, especially in patients with vascular compromise or diabetes.

Surgical excision of the nail matrix is an alternative to chemical ablation but is less commonly performed in routine podiatric practice due to its greater invasiveness and the adequacy of phenolisation in most cases.

Onychauxis, though a benign nail condition, warrants careful assessment and appropriate management to prevent pain, infection, and functional impairment. The cornerstone of treatment remains conservative debridement by a trained podiatrist, supported by emollient therapy, footwear advice, and management of any underlying systemic or dermatological conditions. In refractory or severely symptomatic cases, chemical matrixectomy offers a definitive and effective solution. A patient-centred, holistic approach — considering the individual’s overall health status, lifestyle, and goals — is essential to achieving the best outcomes in the treatment of this common foot condition.

Nails are far more than cosmetic features. As keratinised appendages of the skin, they serve protective and sensory functions, and — perhaps most importantly from a clinical standpoint — they act as visible indicators of systemic health. Among the many nail disorders that dermatologists and clinicians encounter, onychorrhexis stands out for both its prevalence and the breadth of conditions it can signal. Characterised by longitudinal ridging and brittleness that often leads to splitting or breaking of the nail plate, onychorrhexis is a condition worth understanding in depth: its causes, its presentation, its implications, and its management.

Defining Onychorrhexis

The term “onychorrhexis” derives from the Greek words onyx (nail) and rhexis (rupture or fracture). It describes a distinctive nail abnormality in which parallel ridges run lengthwise along the nail plate, from the base toward the free edge. These ridges are frequently accompanied by increased fragility, causing the nail to split longitudinally or flake at the tip. The condition affects fingernails more commonly than toenails and can occur in both males and females, though it is somewhat more prevalent among older adults and women — two groups whose nails may be subjected to different hormonal influences and environmental stresses.

It is worth distinguishing onychorrhexis from a related but separate condition: onychoschizia, in which the nail splits horizontally into layers at the free edge. While both conditions involve nail brittleness and are sometimes grouped together under the broader category of “brittle nails,” their underlying mechanisms and typical causes can differ. Onychorrhexis involves structural disruption running the full length of the nail, suggesting a deeper disruption to nail plate formation at the matrix level.

The Structure of the Nail and How It Goes Wrong

To understand onychorrhexis, one must first appreciate normal nail architecture. The nail plate is composed of densely compacted, dead keratinised cells produced by the nail matrix — the tissue tucked beneath the proximal nail fold. These cells are arranged in horizontal layers and are bound together by intercellular lipids and structural proteins. A healthy nail plate is smooth, resilient, semi-translucent, and firmly adherent to the nail bed beneath it.

When nail matrix function is disrupted — whether by nutritional deficiency, systemic disease, physical trauma, or chemical insult — the orderly production of nail cells is disturbed. The result is a nail plate with structural weaknesses running in the direction of growth: the classic longitudinal ridges of onychorrhexis. These ridges represent lines of reduced cohesion within the nail, and the brittleness arises because the compromised intercellular bonding cannot withstand the mechanical stresses of daily life.

Causes and Risk Factors

The aetiology of onychorrhexis is multifactorial and can be broadly divided into systemic, nutritional, environmental, and local causes.

Among systemic causes, thyroid disorders — particularly hypothyroidism — are among the most frequently implicated. The thyroid hormones play an important role in regulating the growth and differentiation of epithelial cells, including those of the nail matrix. When thyroid function is impaired, nail growth slows and the structural integrity of the nail plate deteriorates. Other endocrine conditions, including hypoparathyroidism and peripheral vascular disease, can similarly compromise nail health.

Nutritional deficiencies are another significant contributor. Iron deficiency is particularly well documented; the nails depend on adequate iron-carrying haemoglobin for their oxygen supply, and when iron stores are depleted, both nail growth and quality suffer. Deficiencies in biotin (vitamin B7), zinc, protein, and essential fatty acids have also been associated with brittle, ridged nails. This connection explains why onychorrhexis is not uncommon in individuals with eating disorders, malabsorptive conditions such as coeliac disease or inflammatory bowel disease, or those following very restrictive diets.

Environmental and chemical factors account for a substantial proportion of cases, particularly among people whose hands are frequently immersed in water or exposed to harsh chemicals. Repeated wetting and drying of the nails causes the nail plate to expand and contract cyclically, weakening its structural integrity over time. Acetone-based nail polish removers, household detergents, and industrial solvents strip the nail of its natural lipid content, leaving it dry and prone to ridging and fracture. This is why onychorrhexis is so common among healthcare workers, cleaners, hairdressers, and others in occupations involving regular hand washing or chemical exposure.

Aging is itself a risk factor. As people grow older, nail growth slows and the water and lipid content of the nail plate naturally decreases, rendering it drier and more brittle. Longitudinal ridging in older adults is so common that mild onychorrhexis is often considered a normal variant of aging rather than a pathological finding.

Dermatological conditions including lichen planus, alopecia areata, and psoriasis can also produce nail changes consistent with onychorrhexis, typically through their inflammatory effects on the nail matrix. Certain medications — particularly retinoids used in the treatment of acne and psoriasis — are known to cause nail brittleness as a side effect.

Diagnosis and Clinical Evaluation

Onychorrhexis is primarily a clinical diagnosis, made on the basis of the characteristic appearance of the nails. However, because the condition can signal underlying systemic disease, a thorough evaluation is warranted when the cause is not immediately apparent. A clinician will typically take a detailed history, asking about occupation, diet, medication use, family history, and the presence of other symptoms that might point toward thyroid dysfunction, anaemia, or connective tissue disease.

Laboratory investigations may include a full blood count, thyroid function tests, serum ferritin, zinc, and albumin levels. In some cases, a biopsy of the nail matrix or nail fold may be indicated to exclude inflammatory dermatoses. Dermoscopy — the use of a handheld magnifying instrument — can assist in characterising the ridging pattern and identifying features that might suggest a specific underlying diagnosis.

Management and Treatment

Treatment of onychorrhexis is guided by its underlying cause. When a systemic condition or nutritional deficiency is identified, addressing that root cause often leads to gradual improvement in nail quality over several months — the timescale reflecting the slow growth of the nail plate (approximately three to four millimetres per month for fingernails).

For cases related to environmental exposure, protective measures are the cornerstone of management. Wearing cotton-lined gloves during wet work, reducing the frequency of nail polish remover use, and applying nail-specific moisturisers or cuticle oils can all help to restore the nail’s lipid content and reduce brittleness. Nail hardeners containing formaldehyde, paradoxically, can worsen brittleness with prolonged use and should be approached with caution.

Biotin supplementation has attracted considerable interest as a treatment for brittle nails, and several small studies have reported improvements in nail thickness and hardness. While the evidence base remains modest, biotin is generally safe and is often recommended in cases where no specific deficiency has been identified. Adequate protein and overall balanced nutrition provide the foundational building blocks for healthy nail production.

Onychorrhexis, though often dismissed as a minor cosmetic inconvenience, deserves thoughtful attention. It is a condition at the intersection of dermatology, internal medicine, and lifestyle, capable of reflecting everything from dietary gaps to thyroid disease to the cumulative toll of occupational chemical exposure. By recognising its characteristic appearance, understanding the diverse factors that contribute to it, and pursuing both systemic and topical treatments tailored to its cause, clinicians and patients alike can address not only the visible signs in the nail but the underlying conditions they represent. In this sense, the humble nail ridge carries a message well worth reading.

Onychophosis is a dermatological condition affecting the toenails, characterised by the hyperkeratotic accumulation of callus tissue within the nail grooves — the lateral and proximal sulci that border the nail plate. Though frequently overlooked or mistaken for other nail pathologies such as onychocryptosis (ingrown toenail) or subungual hyperkeratosis, onychophosis represents a distinct clinical entity that demands targeted management. The condition can cause significant discomfort, particularly in elderly or diabetic populations, and when left untreated, may progress to ulceration, infection, or impaired mobility. Understanding its causes, clinical presentation, and the range of available treatments is essential for effective podiatric care.

Understanding the Condition

The term onychophosis derives from the Greek words for nail (onyx) and callus (phosis), reflecting its defining feature: a localised build-up of hyperkeratotic tissue. This overgrowth occurs primarily in response to chronic mechanical pressure and friction between the nail plate and the surrounding soft tissue of the nail groove. Ill-fitting footwear is among the most common precipitating factors, as narrow toe boxes or excessive pressure from socks and hosiery concentrate force along the nail borders. Biomechanical abnormalities, including hallux valgus, hammer toe deformities, and altered gait patterns, further predispose individuals to this condition by redirecting pressure onto vulnerable nail sulci.

The great toe is most commonly affected, though any digit may develop onychophosis. Patients typically present with pain or tenderness along the nail groove, a sensation of pressure under or beside the nail, and visible thickening of the periungual skin. In severe or long-standing cases, the hyperkeratotic tissue may become macerated, fissured, or secondarily infected, introducing a risk of cellulitis or deeper soft tissue complications, particularly in those with diabetes mellitus or peripheral vascular disease.

Conservative Treatment Approaches

The cornerstone of onychophosis management is conservative, non-surgical debridement, which aims to remove the accumulated keratinous tissue and relieve pressure. This procedure is typically performed by a trained podiatrist using a scalpel, curette, or nail rasp. The practitioner carefully removes the hyperkeratotic material from within the nail sulcus without disrupting the nail matrix or surrounding healthy tissue. Regular debridement — often every six to twelve weeks depending on the rate of recurrence — is effective in managing symptoms and preventing progression for most patients.

Alongside debridement, podiatrists frequently apply emollients and keratolytic agents to soften the thickened tissue and reduce the likelihood of rapid regrowth. Preparations containing urea (typically in concentrations of 10–40%), salicylic acid, or lactic acid are commonly employed. These agents work by disrupting the protein bonds within the keratinised tissue, making it more pliable and amenable to mechanical removal. Patients are often instructed to apply these preparations at home between clinical appointments to maintain tissue suppleness and extend the interval between treatments.

Nail care and patient education are critical adjuncts to clinical treatment. Appropriate nail-cutting technique — trimming straight across rather than in a curved fashion that might encourage lateral nail spicule formation — can reduce mechanical irritation within the groove. Attention to footwear is equally important. Patients should be counselled to wear shoes with adequate toe box depth and width, ensuring that no undue pressure is applied to the nail borders during ambulation. Orthotic devices, toe props, or silicone nail sulcus protectors may be used to redistribute pressure away from the affected grooves, providing both symptomatic relief and a prophylactic benefit.

Advanced Conservative and Adjunctive Therapies

Where standard debridement and topical therapy are insufficient, several more advanced conservative interventions may be considered. Nail bracing, a technique more commonly associated with the management of involuted nails, has been applied with some success in onychophosis by reducing the transverse curvature of the nail plate and thereby alleviating pressure on the lateral sulci. Adhesive brace systems are bonded across the nail surface and gradually flatten the nail’s curvature over several weeks to months. While evidence for their use specifically in onychophosis is limited compared to ingrown nail conditions, the mechanical rationale is sound and the intervention is minimally invasive.

Padding and strapping techniques can also offer temporary but meaningful relief. Felt or foam padding placed adjacent to the nail groove deflects external pressure, while adhesive strapping of the digit can help stabilise soft tissue and reduce shear forces during weight-bearing activities. These methods are particularly valuable as interim measures while longer-term orthopaedic or footwear modifications are implemented.

Surgical and Procedural Interventions

In cases where conservative management fails to provide lasting relief, or where the structural anatomy of the toe perpetuates recurrent onychophosis, surgical options may be warranted. A partial nail avulsion — the removal of the affected lateral strip of nail — can be performed under local anaesthesia to eliminate the nail edge that contributes to sulcus pressure. This procedure is often combined with phenolisation of the nail matrix, in which phenol is applied to the avulsed nail matrix to permanently ablate that portion and prevent regrowth of the offending nail border. This combined partial nail avulsion and phenolisation approach carries a high success rate and low recurrence when performed correctly, making it a reliable option for patients who have not responded adequately to conservative care.

In patients with significant bony deformity contributing to recurrent onychophosis — such as prominent condyles of the distal phalanx or pronounced digital contractures — referral for orthopaedic or podiatric surgical assessment may be appropriate. Procedures such as digital arthroplasty or condylectomy can address the underlying structural causes, potentially offering a more definitive resolution.

Special Considerations in High-Risk Populations

Management of onychophosis in patients with diabetes mellitus, peripheral arterial disease, or immunosuppression requires particular care. In these populations, even minor trauma to the periungual tissue carries heightened risk of infection, ulceration, or impaired wound healing. Debridement should be performed with great caution, using sterile instruments and minimal tissue disruption. Phenolisation is relatively contraindicated in the presence of significant ischaemia, as wound healing may be compromised. Regular podiatric monitoring, appropriate vascular assessment, and multidisciplinary collaboration are essential components of care in these individuals.

Final Word

Onychophosis, while not life-threatening in the majority of patients, can significantly impair quality of life through chronic pain, restricted mobility, and susceptibility to secondary infection. A thorough clinical assessment, tailored to the individual’s anatomy, lifestyle, footwear habits, and comorbidities, underpins effective treatment. Conservative debridement supported by keratolytic agents, footwear modification, and patient education remains the mainstay of management. Where these measures are insufficient, surgical nail procedures or structural corrections offer durable solutions. As with many podiatric conditions, prevention — through appropriate footwear, regular professional nail care, and prompt attention to early symptoms — remains the most powerful tool available.