In this case, it is difficult to assess whether the severity of the clubbed digits is a result of a purely hereditary nature, liver pathology, chronic respiratory ailments, or a combination of the above. The abnormal liver function test may not be related to the digital clubbing. Instead, they may be the result of the alcohol abuse. The case does appear to be hereditary because his siblings and mother all have clubbed digits and there is a higher frequency in blacks. The authors believe that this case affords an opportunity to make the podiatrist aware of the possibilities that should be considered the differential diagnosis when examining a patient with clubbed digits. It is important to fully work up a patient with clubbed digits even if the presentation is that of hereditary clubbing. Severe clubbing may be the result of a mild hereditary form that was worsened by an underlying systemic condition, such as malignancy, toxicosis, endocrinopathy, and neuropathy.