Toenail problems

Your feet: indicators of health

Because they are so far away from our heart, problems with our feet are often the first indication that something is wrong with our circulation.

The condition of our toenails can also signal the presence of several diseases. For example, toenails that
are thin, curve upwards, or have raised ridges on the surface can indicate iron deficiency or anaemia (a shortage of iron carried by the blood). Increased nail thickness; or bumps on the nail; can be manifestations of psoriasis, a skin condition.

Your podiatrist will check the condition of your toenails and help you understand the health implications of their appearance, as well as providing a range of treatments for any toenail problems

Our toenails

The key parts of the toenail are:

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

Toenails grow constantly. Healthy nails are pink, free of dirt or impairment, and grow naturally along the sulcus. It takes up to 12 months to replace the toenail of your big toe.

Who gets nail problems?

Toenail problems are relatively common in people of all ages. They can become thick, brittle, curved,
discoloured, infected, bumpy or grooved. In some cases, the nail falls off and a new one grows. 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, trauma, infection or poor circulation. Major toenail issues can be attributed to incorrectly fitting shoes, which press too tightly on the toenails. Injuries, such as bruising under the nail or infection, can cause permanent nail deformity.

Common conditions and treatment

Ingrown toenails

A common toenail problem. They may be caused by improperly trimmed toenails, very curved nail edges, shoe pressure, or repeated trauma to the feet from daily activities. A predisposition for ingrown toenails may also be inherited. Pain in the sulcus can also be caused by a corn or callus under the nail edge.

Most cases will require conservative treatment, but some may require minor surgical correction that can be conducted very easily in your podiatrist’s clinic using a local anaesthetic.

Thickened nails

Also a common condition. A single thickened nail is usually the result of injury to the nail bed, such as dropping something heavy on your toes, or fungal infection. They can be easily and painlessly thinned down by your podiatrist.

Fungal infections

Among the most troublesome of nail conditions to treat. They are often characterised by thickening, discolouration and separation of the nail from the nail bed. In some cases, the nail crumbles. These infections tend to stay in the nail if they are not treated and can infect the nail bed.

There are a range of anti-fungal medications available for treatment. Your podiatrist can assist with the trimming and care of unhealthy nails.

Other infections

May include inflammation of the matrix (onychia) or inflammation of the tissue adjacent to the nail (paronychia). In people with lowered immunity, such infections may lead to serious complications; including more widespread infection extending up the leg. Your podiatrist can assist by detecting such infections early and forming a suitable treatment plan.

Trauma

Trauma to the nails may lead to permanent nail deformity. This can be cared for by simple, 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, brittle and thickened nails.

Many older people do not have the strength, flexibility or eyesight to trim their nails – particularly if the nails are deformed. You should seek podiatric care for these services and for safe self-care advice.

Warning signs

Any sudden changes in colour or shape of the toenail, signs of infection, development of a freckle under the nail, or unexplained pain should be discussed with your podiatrist immediately. Your podiatrist can diagnose the problem and arrange appropriate treatment.

Taking care of your nails

  • Trim toenails straight across to a length just below the end of the toe.
  • 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 stocking that are not too restrictive (unless prescribed).
Last Reviewed: 1 July 2016
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.