We know that it can be concerning when you look at your toenails and they just don’t look right! You may find yourself asking Dr. Google one of the following questions… (we’ve all been there!)
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My toenail is digging in to the side of my toenail, what is this?
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My toenail has bumps in it, what is this?
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My toenails are peeling, what is this?
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My toenail is a funny colour, help!
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Should I see a GP?!
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Should I see a Podiatrist? When should I see a Podiatrist?
No need to turn to Dr. Google, our Podiatrist’s are here to answer your questions about different toenail conditions. In this post, we break down the different toenail conditions, show examples in photos and discuss causes and treatment options for each conditions.
Ingrown toenails
We, Podiatrists call ingrown toenails ‘Onychocrytosis’, the inclusion of the word ‘cry’ 😢 in this term is very fitting.
An ingrown toenail is when a toenail edge presses against and irritates the nail fold or adjacent skin. Ingrown toenails can have associated pain, infection, corns, calluses and extra tissue growth called Hypergranulation.
An ingrown toenail may be caused or contributed by one or more of these conditions:
👉 Involuted (excessively curved) toenails
👉 Trauma to the toenail
👉 Toenails that are too wide and flat for the nail bed
👉 A nail spike or sharp edge that has been left in the corner when trimming
👉 Toe deformities (claw toes, bunions)
👉 Faulty foot posture and biomechanics
👉 Shoes that are too tight around the toes
👉 Genetic predisposition to an abnormal nail shape
👉 The medication Isotretinoin (Roaccutane©)
👉 Sweaty skin
Treatment can include:
✅ Toenail bracing where a smooth wire or plastic device is glued to the toenail like braces are applied to teeth. A gentle force within the brace encourages the nail to reposition.
✅ Skillful trimming of the nail edge to remove the offending nail spike, sharp edge or involution edge.
✅ Packing of the edge with material to prevent nail and skin fold contact.
✅ Toenail surgery under local anesthesia the offending section of the toenail is removed.
These treatments are often accompanied by topical antiseptics, oral antibiotics, dressings, preventative education and at home care advice.
Toenail Psoriasis
A few signs of psoriasis in the toenails include
Pitting: small dents or pits may appear on the surface of the toenail. These pits are usually shallow but can vary in depth.
Thickening: psoriatic toenails may become thicker than normal. This thickening can affect both the nail plate and the surrounding skin.
Crumbly ‘friable’ texture: which makes the nail more prone to breaking and crumbling.
A separation of the nail from the nail bed. This increases the risk of a fungal infection to the nail bed.
Discolouration: a yellow-brown colour change may occur.
The causes of psoriatic toenails are the same as psoriasis. Psoriasis isn’t fully understood in research and medicine so we think it’s a combination of contributing factors.
Contributing factors that can contribute to toenail Psoriatic Toenails include:
Genetics; if you have a family history of psoriasis you are more susceptible to psoriatic toenails.
An autoimmune disorder; where the immune system mistakenly attacks healthy cells, including those in the skin and nails. This immune system dysfunction leads to the inflammation and abnormal cell growth characteristic of psoriasis. Another example of an autoimmune disorder is psoriatic arthritis which is when there is joint inflammation, there may or may not be skin involvement.
Environmental triggers; Common triggers include stress, infections, injury to the nails, and exposure to certain medications.
Inflammation; in the nail matrix and bed. The inflammatory response contributes to the changes in nail texture, thickness, and appearance.
If you suspect you have psoriasis or psoriatic toenails, it is advisable to consult with a dermatologist or general practitioner for a formal diagnosis. They can advise if medication or light therapy is required.
For Psoriatic Toenails a podiatrist can help by:
Trimming the toenails and burring the thickness of the toenails down
Reducing any associated callus around the toenails
Providing advice on at home care including what cream to apply
Discuss if any pressure alleviating devices such as silicon toe caps are required.
Thickened Toenails
The medical term of a thickened toenail is called ‘Onychauxis’. This means uniform thickening of the nail plate. The cause of thickened toenails can be due to damage to the nail matrix which allows the nail to grow.
Causes of thickened toenails includes:
👉 Single major trauma e.g. heavy blow
👉 Repeated micro-trauma e.g. from poor fitting footwear
👉 Fungal nail infection, chronic skin disease
👉 Systemic disturbance (if all nails involved) e.g. peripheral arterial disease, which is an obstruction of blood flow.
The podiatry management of thickened toenails include:
✅ A Podiatrist can burr the nail to as near normal thickness as possible = reduced pressure and pain.
✅ Assess footwear. It
won’t reverse the problem, but it will help to reduce pain from pressure on nail.
✅ Control / stabilisation of underlying system condition (if present).
✅ Total Nail Avulsion (TNA) with destruction of matrix may give permanent relief.
Do you have a thickened toenail? See one of our Podiatrists for treatment now by booking online or calling 61984818.
Brittle Toenails
Brittle toenails may be dry, thick, crumbly and break/split/crack easily. When toenails are crumbly, Podiatrists use the term ‘friable’.
Brittle toenails are more likely to occur with:
Fungal infections: the fungus changes the nail structure.
Trauma: either a blunt blow or from repetitive trauma such as from tight shoes.
Poor nail care: from the use of harsh nail products or over filing.
Nutritional deficiencies: limited protein, biotin, iron and vitamins in your diet can contribute to brittleness.
Medical conditions: such as psoriasis, poor circulation and thyroid disorders.
Age: as we age, nails aren’t built the same and can become more dry and brittle.Treatment for brittle toenails depends on the underlying cause such as treating a fungal infection, wear well-fitting shoes, avoiding harsh chemicals and supplements for nutritional deficiencies.
What are the podiatry treatment options for Brittle Toenails?
At New Step Podiatry we often recommend trying the Hydration Moisture Treatment by Dr’s Remedy. This clear coat helps moisturize, strengthen, and protect the look of nails. It is infused with biotin, whole wheat protein and four major vitamins. Wear alone as a treatment or as a base coat under a Dr’s Remedy nail polish colour.
Bruised/Traumatised Toenails
As there is no way for the dried blood to be removed you have to wait for it to grow out, unless of course the nail falls off before this can occur.The types of trauma that cause a black toenail can be divided into ‘micro’/’repetitive’ trauma or a ‘blunt’ sudden macro trauma.
Examples of blunt trauma are dropping something heavy on your foot, someone treading on you (soccer players 
in particular!) and kicking something hard 
Sometimes if you are fast enough after the trauma, a doctor or podiatrist can reduce the amount of blood that stays under the nail by piercing the nail plate and squeezing out the fresh, liquid blood. Although this is painful to do, the less blood trapped under the toenail means less pressure and pain for a few days. This is more common in elite sports players as they may not want to spend a couple of days training and playing with a sore toe.For people that have dried blood under the toenail, a Podiatrist will provide the following:
Filing / burring of any thick nail and surrounding callus. This will help reduce thick nail and skin pressure on the sensitive nail bed. Trimming of lifting / falling off toenail. Removing this will reduce the risk of catching and further trauma. Advice on whether preventative antifungal or antibacterial topicals are required. Advise on how to look after your toenail when it is growing back. A traumatised toenail is more at risk of ingrowing when it grows back. If a podiatrist thinks your toenail is at risk of ingrowing, follow up appointments may be required to review. Advice on how to prevent micro trauma including footwear and toe alignment advice.It must be noted that skin cancers such as melanomas can form under toenails and cause black discolouration. This discolouration will not grow out and usually forms in a streak. If you are concerned that your black toenail is a melanoma, consult a Podiatrist, GP or skin specialist.
Fungal Toenails
Toenail fungus, referred to as ‘onychomycosis’ by medical professionals, is one of the most common conditions affecting the toenail.
Onychomycosis usually presents with nail discoloration, such as white, brown or yellowing of the toenail. It can also present as nail thickening and/or lifting.
The typical causes of onychomycosis include:
– Trauma to the nail
– Poor foot hygiene
– Sharing shoes
– Undertaking activities, or going barefoot, in shared spaces such as at the swimming pool, sauna or gym etc.
How does a Podiatrist treat fungal infections?
Onychomycosis is usually managed by your podiatrist who will regularly reduce the infected sections of toenail in addition to recommending either topical anti-fungals (such as Loceryl) and/or oral anti-fungals (requiring a script from your GP).
It’s important to remember that onychomycosis is best treated early and chronic infections can be difficult to treat, often taking a long time (12+ months) to resolve!
If you have any of the above toenail conditions, or are concerned about the appearance of your toenails, book in now to see one of our Podiatrists to help put your mind at ease! Our podiatrist’s can diagnose, treat and help manage chronic toenail conditions.
Your condition not listed above? Not to worry! Check out our social media for more Toenail Tuesday posts and stay tuned for Part 2!
