Nails are an extension of the top layer of the skin and are composed of a nail plate (top layer) and nail bed (skin below the nail plate). The nail matrix is the region where your toenail begins to grow. Nails are made of keratin (protein) and help to protect your fingers and toes from injury. Toenail conditions can range from minor infections to severe trauma. A foot and ankle surgeon is a doctor specializing in the treatment of foot problems including toenail conditions.
Types of Toenail Conditions
Some of the common toenail problems are discussed below:
An ingrown toenail is a common and painful condition of the toe. It occurs when the sides or corners of the nail grow inwards and penetrates into the skin of the toe. The condition is often hereditary but can occur due to the overuse of the foot in athletes. Pain is often accompanied by swelling and redness (if infected). Most often the big toe is affected.
Bacterial infection of the skin around the toenail is caused by Staphylococcus and Enterococcus. The condition is called Paronychia.
Fungal infections commonly occur in toenails. Termed as onychomycosis, nail fungus affects the keratin, the hard material that makes up the nail and can include the entire nail or a portion of the nail, along with the nail root, plate or bed. It gradually leads to thickening, distortion, and discoloration of the nails. Untreated fungal infections begin to spread to the nearby tissue and can cause difficulty walking.
Nail Bed Injuries
Nail bed injuries such as crush and avulsion injuries commonly occur when the nail bed gets compressed between the hard nail on the top and the toe bone below it. Nail bed injuries are typically accidental. Bleeding and discoloration occur and your nail may be torn off exposing the nail bed underneath.
Subungual hematoma is an accumulation of blood under your toenail that occurs if a heavy object drops on your foot or if you stub your toe. Wearing ill-fitting shoes while running or playing sports activities may also cause a subungual hematoma. Nail discoloration and pain occur and go away usually in a few days.
Clubbing of toenails refers to a change in the shape of the nail due to the enlargement of its tip. The nails curve and take on the appearance of an upside-down spoon. Nail clubbing indicates an underlying medical condition such as lung cancer, heart disease, gastrointestinal and endocrine problems.
Leukonychia are tiny white spots or large lines on the nails that occur due to a nailbed injury. Leukonychia indicates an underlying medical condition such as heart disease, kidney problems, arsenic poisoning, mineral deficiency or allergy to certain chemicals. A fungal infection may also cause white spots.
Your doctor will assess your symptoms and take a medical history. Your toenail will be physically examined for any abnormal changes. Nail clippings and scrapping beneath your nail may be obtained for laboratory analysis.
Treatment depends on the type of toenail condition. Your treatment plan may include:
- Pain medication to relieve pain
- Antibiotics to treat a bacterial infection
- Antifungal medications and topical ointments for fungal infection
- Medications to relieve an underlying medical condition
- Treatment of contributing skin disease
- Surgery for conditions like ingrown toenails
Toenail conditions can be prevented by following self-care practices that include:
- Eating a healthy diet
- Quitting tobacco use (smoking)
- Keeping your feet dry and clean
- Wearing proper-fitting shoes
- Avoiding improper trimming of nails
- Avoiding the use of harsh soaps and detergents
- Moisturizing your feet regularly
- Soaking your feet in Epsom salt solution followed by a massage