An Overview of Common Toenail Problems

Common toenail problems include fungal infections, ingrown toenails, and trauma (injuries). You may notice toenail symptoms such as:

• Crumbling
• Thickening
• Discoloration (such as black toenail)
• Swelling
• Pain
• Warmth
• Falling off

This article provides an overview of the three most common toenail problems, as well as their symptoms, causes, and treatment options.

Ingrown Toenail

An ingrown toenail occurs when the edge of the toenail, usually on the big toe, grows into the skin next to it (called the lateral nail fold).

Ingrown Toenail Symptoms

An ingrown toenail causes pain and swelling at the side of the toe. It may get infected, which can trigger:

• Redness or dark discoloration, depending on your skin tone
• Additional swelling
• Pain
• Warmth
• Discharge

Note that the ingrown part of the nail is usually unseen because it's below the skin. 

Causes of an Ingrown Toenail

Factors that increase your chance of developing an ingrown toenail include:

• A family history of ingrown toenails
• Abnormal toe shape
• Advancing age
• Fungal infections
• Health problems like poor leg circulation or lung disease
• Improperly fitting shoes or socks 
• Nail trauma
• Toenails that are clipped too short
  

Treating an Ingrown Toenail

You can treat most ingrown toenails at home unless you:

• Suspect an infection
• Have diabetes
• Have nerve damage (neuropathy)
• Have poor circulation

In those cases, you should see a healthcare provider such as a podiatrist (foot specialist).

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. 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.

Toenail Fungus

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 tip of the nail, where you trim it.

Toenail Fungus Symptoms

The most common symptoms of toenail fungal infections include:

• An increase in white debris beneath the nail
• Crumbling
• Discoloration beneath the nail (usually brown, white, or yellow)
• Loosening or separation of the infected part of the nail from the nail bed
• Thickening of the nail

Less often, an infection can appear as a white, powdery discoloration on top of the nail. 

Causes of Fungal Infections

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, certain diseases (e.g., diabetes, circulation problems), and a suppressed immune system.

Other risk factors include:

• Frequent fungal skin infections
• Hyperhidrosis (a tendency toward sweaty feet)
• Wearing closed shoes for long periods of time (fungi thrive in moist, dark, and warm environments)
• Trauma to the nail

Treating Toenail Fungus

Treatment at a foot specialist (podiatrist)'s office will likely involve something called debridement (trimming away thickened areas). This can relieve pain from the thick nail pressing against your shoes.

Debridement may also make topical treatments more effective.

Oral (taken by mouth) antifungal medications and/or prescription-strength topical treatments (applied to the skin) may also be prescribed. However, oral antifungal medicines aren't always a good choice due to their potential side effects and cost.

You can buy a lot of over-the-counter (OTC) 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 a laser treatment that has been cleared by the U.S. Food and Drug Administration (FDA).

Toenail Trauma

Trauma to the toenail can be chronic (long-lasting) or from an acute (short-term) injury.

Toenail Trauma Symptoms

Toenails grow from an area below the skin known as the matrix, which is connected to the blood vessel and nerve-rich nail bed beneath it.

Injury to the matrix can result in a number of possible toenail changes, including bruising beneath the toenail, thickening, and nail loss.

Causes of Toenail Trauma

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.

If trauma makes any part of the nail become loose or separated from the nail bed, it can lead to a secondary bacterial or fungal infection. This can cause dark discoloration of the toenail.

Acute trauma may also result in a fracture (break) of the bone beneath the nail, to which the nail is in close proximity.

Treating Toenail Trauma

Depending on the injury, treatment for toenail trauma can include home care or a trip to see a healthcare provider.

For most minor toenail injuries, you can:

• Trim or file any rough edges so it doesn't catch on anything
• After trimming, soak your toe in cold water for 20 minutes
• Apply petroleum jelly (Vaseline)
• Cover with a bandage

For a large tear, trim off the detached part or cover it with an adhesive bandage until it grows out enough to protect the sensitive skin underneath.

You can prevent an infection by:

• Soaking your foot in warm salt water for 20 minutes several times a day for 3 days
• Using petroleum jelly and a fresh bandage after each soak
• Keeping the area clean, dry, and covered until either the nail grows back or the nail bed becomes firm

See a healthcare provider if you suspect your toenail is infected. Symptoms include:

• Pain
• Swelling
• Heat
• Discoloration
• Draining pus

Sometimes, a healthcare provider will drill a hole in or surgically remove a damaged toenail. This is done to relieve pressure from swelling.

When the new nail grows in, it probably will be thickened or disfigured due to the damaged matrix.

Summary

Toenail fungus, ingrown toenails, 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.

You may be able to treat your toenail problem at home. However, certain problems warrant medical attention. You may need oral medication or a procedure like a debridement or toenail removal.