Toenail problems

Your feet: indicators of health

Because they are so far away from our heart, our feet are often the first part of the body to show something is wrong with the way blood circulates in our body. The condition of our toenails can signal the presence or beginning of several diseases. For example, toenails that are hollow instead of being rounded can indicate iron deficiency or anaemia (a shortage of red blood cells). Increased nail thickness, or bumps on the nail, can be manifestations of psoriasis, a skin disease.

Our toenails

The major parts of the toenail are:

  • the nail itself (or the nail plate);
  • the matrix, where the nail grows from;
  • the lunula, the white, moon-shaped area at the base of the nail;
  • the nail bed, or the tissue on which the nail lies; and
  • the sulcus, or the groove at the side in which the nail sits.

Healthy nails are pink, free of dirt and impairment, and grow into the grooves normally. Toenails grow constantly. It takes up to 12 months to replace the toenail of your big toe.

Who can have nail problems?

Toenails of people of all ages can undergo a range of changes, some of which are relatively common. They can become thick, brittle, curved, discoloured, infected, clubbed, bumpy and grooved. In some cases, the nail falls off and a new one grows in. As we grow older, we are more likely to develop toenail problems.

What causes nail problems?

Toenail problems may be caused by warts, tumours under the nail, infection, or poor circulation. Major toenail problem culprits are incorrectly fitting shoes, which press too tightly on the toenails. Injury, such as bruising under the nail and infection, can cause permanent nail deformity.

Common conditions and treatment

Ingrown toenails

This is the most common toenail problem. Ingrown toenails may be caused by improperly trimmed toenails, very curved edges of nails, shoe pressure or repeated trauma to the feet from normal activities. They may also be inherited. Frequently, the pain is due to corns or calluses in the groove (or sulcus) of the toenail. Most cases will require conservative treatment, while others may need a minor surgical correction, which can be conducted in your podiatrist's rooms using a local anaesthetic.

Thickened nails

This is a common condition. It is usually the result of injury to the nail bed, such as dropping something heavy on your toes, or fungal infection. Thickened nails can be thinned down by a podiatrist easily and painlessly.

Fungal infections

Fungal infections are among the most troublesome of nail conditions to treat. They are often characterised by thickening, discoloration and separation of the front of the nail from the nail bed. In some cases the nail crumbles. These fungal nail infections tend to stay in the nail if they are not treated, and can infect the nail bed. There is a range of antifungal medications available for treatment, so see your doctor. Your podiatrist can assist with trimming and care of out-of-shape nail plates.

Other infections

Other nail infections can cause inflammation of the matrix (onychia) and inflammation of the tissue adjacent to the nail (paronychia). In people with lowered immunity, this may sometimes lead to serious complications, including more widespread infection extending up the leg. Your podiatrist can detect such infections early and form a suitable treatment plan.


Trauma to the nails may lead to permanent nail deformity. This can be cared for by regular, non-painful podiatric treatment, involving filing and possibly the use of a special drill.

Older people and nail problems

Older people with poor circulation are prone to fragile or brittle nails. Many older people do not have the strength, flexibility, or eyesight to trim their nails, especially if the nails are deformed. They should seek podiatric care for these services, and advice regarding safe self care.

Warning signs

Any sudden changes in colour or shape of the nail, sign of infection, development of a freckle under the nail, or pain should be discussed with your podiatrist. Your podiatrist can diagnose the problem and then recommend an appropriate treatment.

Taking care of your nails

  • Trim toenails straight across to a length just below the end of the toe. Do not round off the corners—this can cause ingrown toenails.
  • Use a strong pair of nail clippers.
  • After clipping, smooth nails with a file or emery board, using downward strokes.
  • Wear only properly fitted shoes, not short or narrow ones.
  • Wash feet regularly, especially between the toes, and dry thoroughly.
  • Wear socks or stockings that are not too restrictive.

Your podiatrist

Regular visits to your podiatrist can help prevent foot problems, alleviate pain, and help keep you on your feet and mobile.

Last Reviewed: 22 June 2007
Reproduced with kind permission of the Australasian Podiatry Council.
Australasian Podiatry Council

Australasian Podiatry Council

The Australasian Podiatry Council is responsible for the preparation of national policies and clinical practice, representation of podiatry in Australia to government and industry bodies, research within the discipline and support for continuing professional development.