Leah Ansell, MD, is a board-certified dermatologist and an assistant professor of dermatology at Columbia University.
Learn about our Medical Review BoardAll things considered, toenails are tough and tend to hold up well. That's thanks to keratin, the tough protein they (and the top layer of your skin) are made of. You may even forget they're there—until a problem crops up.
Your toenails confront a great deal of stress every day. They rub against shoes, become stubbed, and can be exposed to bacteria and fungi. This can cause the nail to thicken, discolor, or break down. It can also cause discomfort and infection.
This article provides an overview of the three most common toenail problems, as well as their symptoms, causes, and treatment options.
1:59This video has been medically reviewed by Casey Gallagher, MD.
Toenail fungus, or onychomycosis, is a slow-growing infection of the nail and skin beneath it.
Fungal infections usually occur underneath the nail and begin at the end of the nail, where it gets trimmed.
The most common changes that occur with toenail fungal infections include:
Less often, an infection can appear as a white, powdery discoloration on top of the nail.
Toenail fungal infections are usually caused by the same type of fungi that cause athlete's foot. In fact, people who are prone to athlete's foot may also be susceptible to toenail fungal infections.
Toenail fungus can affect anyone, but it becomes more prevalent with age.
Individuals with certain diseases, such as diabetes and conditions that affect limb circulation, are more susceptible to fungal nail infections as well. So are people who have suppressed immune systems.
Other risk factors include:
Toenail Fungus and TreatmentsTreatment at a foot specialist (podiatrist)'s office will likely involve debridement. This is the process of trimming down the nail to remove thick areas and relieve discomfort that may occur with shoe wear. Debridement may also improve the effectiveness of topical treatments.
Oral antifungal medications (taken by mouth) and/or prescription-strength topical treatments (applied to the skin) may also be prescribed. However, oral antifungal medicines are not always an option for many people due to their potential side effects and cost.
There are a number of over-the-counter topical medications for toenail fungus. However, since the fungus resides deep in the nail and underneath it, these medications have limited success in treating toenail fungus. This is especially true if it has spread significantly throughout the nail.
The good news is that other fungal nail treatments are available, including laser treatment that has been cleared by the U.S. Food and Drug Administration (FDA) for this purpose.
Toenail fungus is a slow-growing infection of the nail and skin beneath it. Podiatrists often treat it by trimming the nail and removing thickened areas.
An ingrown toenail occurs when the edge of the toenail, usually the big toe, grows into the skin next to it (called the lateral nail fold).
An ingrown toenail causes pain at the side of the toe, along with swelling. It may become infected, which can trigger redness, more swelling, pain, warmth, and/or discharge.
Note that the ingrown part of the nail is usually unseen because it is below the skin.
Factors that increase a person's chance of developing an ingrown toenail include:
Ingrown Toenail Causes, Symptoms, TreatmentTreatment for an ingrown toenail can be performed at home unless there is a suspicion of an infection or if you have a medical condition, such as diabetes, nerve damage, or poor circulation. Then a podiatrist should take the lead.
The first step for at-home care is to soak your foot in an Epsom salt solution using room-temperature water. Then massage the side of your nail gently to decrease inflammation.
Be sure to not cut your toenail and consider wearing open shoes like sandals until the problem resolves.
In addition, you may have to take a closer look at the fit and shape of your shoes and socks to see if they're causing the problem. They may be too tight. The health of your feet, not fashion, should guide your shopping.
If your healthcare provider suspects an infection, you may need an antibiotic. In addition, the provider might have to remove part of or your entire toenail to ease the inflammation.
An ingrown toenail occurs when the edge of the toenail, usually the big one, grows into the skin next to it. It can uncomfortable, but can usually be addressed with an Epsom salt soak.
Trauma to the toenail can be chronic or occur as a result of an acute injury.
Toenails grow from a center area below the skin known as the matrix. It is connected to the blood vessel and nerve-rich nail bed beneath it.
Injury to the matrix can result in a number of possible changes to the nail, including bruising beneath the toenail, toenail thickening, and toenail loss.
1:38This video has been medically reviewed by Casey Gallagher, MD.
Toenail trauma may happen because of repetitive rubbing against a shoe when walking or running. It may be that your new shoes are too tight or loose, which can lead to more friction against your toe.
Trauma can also be the result of a sudden injury, such as stubbing your toe or dropping an object on it.
Toenail trauma can result in a secondary bacterial or fungal infection if any part of the nail becomes loose. This can lead to the dark discoloration of the toenail. Acute trauma may also result in a fracture of the bone beneath the nail, to which the nail is in close proximity.
It's best to have any toenail color changes or toenail loosening evaluated by a podiatrist or other healthcare provider. Although infrequent, black or brown discoloration could be a sign of skin cancer melanoma.
Having a thick or otherwise damaged toenail removed surgically will probably not result in a healthier nail growing in its place. Once a nail's matrix is damaged, it usually continues to produce a thickened or disfigured nail.
Toenail trauma can lead to discomfort, nail color changes, and infection. It could be due to an obvious cause, like dropping something on the toe, or even constant rubbing of the toenail against your shoe.
Toenail fungus, ingrown toenail, and toenail trauma are three of the most common toenail problems. Each one can be traced to various causes, which in turn leads to varying treatment options.
The good news is that, in most cases, you don't have to live with a toenail problem any longer than you care to. Most of the treatment options are simple and straightforward.
If you have a toenail problem, you may feel embarrassed by its appearance—maybe so much so that you put off seeing a healthcare provider.
While your toenail issue may have a simple explanation that resolves on its own in short order, it could also be a sign of an underlying health issue. Only a visit to your healthcare provider can clear this up.
Remember that they are there to help—and the sooner an issue is caught, the better chance there likely is to address it effectively.
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