This is perhaps among the more popular questions I get asked. Toenails and also fingernails, for that matter, exist to protect the tips of the fingers and toes including soft tissue and bone against any possible trauma. The ability to decorate nails with manicures and pedicures is just an added bonus!
The anatomy of the nail is both intricate and interesting. There are many parts that make up the nail including: the nail plate, the nail bed, lunula, cuticle, matrix, and the nail folds. The visible portion of the toenail is called the nail plate which is comprised of a sheet of protein called keratin. Toenails form the largest sheet of keratin in the body and this is of significance because it does more than protect the toes. It also reflects health events of the past several months. For instance, a transverse ridge across the nails can be seen in months following a cardiac arrest.
The appearance and growth pattern of the toenails can speak to the overall health of an individual. A number of small branches of blood vessels supply the toes and nail beds to keep the toenails nourished. Therefore, it is natural to expect pathological changes to the nails with lack of adequate blood supply. Another factor to keep in mind is the growth rate of toenails which is much slower than that of fingernails - 1.62mm per month to be precise. Therefore, any changes that affect the health of toenails can take several months to appear on the nail plate. It can take a toenail 1-1.5 years to fully grow from the matrix to the tip of the toe. With so many variable factors that determine the fate of toenails, one can expect that many variations of toenails also exist. For the topic of this discussion, I will be focusing on a few common conditions.
Fungal Toenails
As I learned in podiatry school, 'fungus is among us.' Fungus is found everywhere: in the air, our surrounding environment, our shoes/socks, and even on our bodies. When toenails undergo trauma or microtrauma, the nail plate lifts and separates from the nail bed. This makes toenails vulnerable to fungal infections. Trichophyton rubrum is the most common offending organism found in fungal toenails. Fungal toenails become dystrophic, discolored, and brittle. If your toenails appear yellow, thick, and become chalky when you trim them, they may be fungal.
As common as toenail fungus is, it can also be difficult to treat and eradicate. Fungus thrives in dark, warm, and moist environment so our feet make a perfect house for it. In severe cases, these dystrophic nails can cause pain due to their deformity and can even cause irritation and wounds as they get caught on socks and bedsheets. Despite the high recurrence, there are many options to treat fungal toenails. These range from topical therapy, oral therapy, laser therapy, and nail surgery. Talk to a podiatrist about which options may be best suited for you.
Ingrowing Toenails
A toenail is ingrown if the edge or the corner of the toenail grows into the skin adjacent to the nail. The big toenail is most commonly affected by this. The age range for developing ingrowing toenails varies widely and can affect anyone from a young child to an elderly person. Unlike fungal toenails, ingrowing toenails usually cause much pain and discomfort and can't be ignored too long due to the risk of developing an infection.
There are a number of factors that can cause toenails to become ingrown. Some common reasons are as follows:
The shape of the toenail - some nails are “C” shaped or curved which make them prone to be ingrown.
Improper shoe gear - shoes that are too tight in the toe box can make toenails prone to becoming ingrown.
Cutting the toenails incorrectly - yes, there is a correct way of cutting nails!
'Digging' into the nails to self treat ingrowing toenails
Trauma to the nail
Genetic predisposition
Having suffered from painfully recurring ingrowing toenails myself, I know too well the complications that go with treating them. If you are suffering from pain and discomfort of ingrowing toenails, it is time to get them treated. If the surrounding skin becomes red, swollen, and there is any drainage or foul smell accompanying, there may be an associated infection that warrants immediate attention. Talk to a podiatrist about treatment options for ingrowing toenails. My only regret is not getting them treated sooner!
Traumatic Toenails
When an objects falls on your toes or you stub your foot, toenails are first in line to defend the soft tissue and bone beneath. Initially following the trauma, the toenail(s) and/or the associated toe(s) can become black and blue as the nail bed and soft tissue bleed. Sometimes, this warrants emergent surgical intervention to prevent pressure from building up in the tissue. If any deeper injuries are sustained to the bone and joint beneath, then a podiatrist should be consulted without delay to get prompt treatment.
Major trauma aside, toenails can also become injured from repetitive micro trauma from activities like hiking, running, dancing, kicking, jumping; especially in tight fitting shoes. As the toes bend during toe off portion of the gait cycle, they hit the toe box of the shoes. Constant repetitive pattern of hitting the toe box can make toenails vulnerable to micro trauma and cause them to become black and blue and even come off altogether.
As your toenails heal from trauma, be on the lookout for a lose nail, any fungal and/or ingrowing tendencies as trauma is a leading cause for this. Whether you are concerned about fungal, ingrowing, traumatic or other changes to your toenails, talk to a podiatrist about the health of your toenails.
Resources:
Yaemsiri, S et al. “Growth rate of human fingernails and toenails in healthy American young adults.” Journal of the European Academy of Dermatology and Venereology : JEADV vol. 24,4 (2010): 420-3. doi:10.1111/j.1468-3083.2009.03426.x
Beaven, Donald Ward, and Stafford Eric Brooks. Color Atlas of the Nail in Clinical Diagnosis. Times Mirror International Publishers, 1994.
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