An overview of common toenail problems

Toenails are thickened extensions of the top layer of our skin and are made up of the same strong protein called keratin. The nail grows in an area under the skin known as the matrix and is closely associated with a blood vessel and a nerve-rich nail bed underneath.

Toenails are exposed to a lot of stress, whether it's rubbing a shoe, a bruised toe, or the constant presence of bacteria and fungi (imagine the environment inside a shoe). In light of these conditions, we often see three common toenail problems.

Toenail fungus

Foot with nail fungus. daizuoxin / Getty Images

Toenail fungus, or onychomycosis, is an infection that grows slowly on the nail and the skin underneath.

Symptoms of toenail fungus

Fungal infections usually occur under the nail and begin at the end of the nail (where it is trimmed). The most common changes that occur with toenail fungal infections include:

  • Discoloration under the nail, usually brown, white, or yellow.
  • Thickening of the nail
  • An increase in the amount of white dirt under the nail, which is keratin, the protein that shapes the skin and nails.
  • Loosening or separation of the infected part of the nail from the nail bed
  • Brittle nail appearance

Less commonly, the infection may manifest as a powdery white discoloration on the top of the nail.


You may be surprised to learn that toenail fungus infections are usually caused by the same type of fungus that causes athlete's foot. In fact, people prone to mycosis of the feet may also be susceptible to fungal toenail infections .

Toenail fungus can affect anyone, but it becomes more common with age. People with certain medical conditions, such as diabetes and conditions that affect blood flow to the extremities, are more susceptible to fungal nail infections, as are people with weakened immune systems. Other risk factors include:

  • Hyperhidrosis or a tendency to sweaty feet.
  • Frequent fungal infections of the skin.
  • Nail injury
  • Shoes that provide a moist, dark, and warm environment for fungal growth.

Watch out

Treatment at the podiatrist's office will likely include debridement or trimming and removal of debris and the deadly nail. This will help reduce the thickness of the nail and reduce the discomfort that can occur when wearing shoes. Removing the wound can also improve the effectiveness of topical treatments.

Oral antifungal medications and / or topical prescription medications may also be prescribed. However, oral antifungal medications are not always suitable for many people due to potential side effects and costs.

In addition, there are several over-the-counter topical medications for toenail fungus. However, because the fungus is deep in and under the nail, these medications have limited success in treating toenail fungus, especially if it has spread significantly on the nail.

The good news is that there are other treatments available for nail fungus, including laser treatments that have received FDA approval .

Ingrown toenail

Ingrown toenail. Ilya Anatolyev / Getty Images

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

Ingrown toenail symptoms

An ingrown toenail causes pain and swelling on the side. It can become infected, which can cause redness, increased swelling, pain, warmth, and / or discharge. Keep in mind that an ingrown toenail is usually not visible because it is under the skin.


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

  • Inappropriate shoes or socks
  • Abnormal shape of the toe
  • Nail injury
  • Very short toenails
  • Family history of ingrown toenails
  • Fungal infection
  • With age
  • Health problems such as poor circulation in the legs or lung disease .

Watch out

Treatment for ingrown toenails can be done at home if there is no suspicion of infection or if you have a medical condition such as diabetes , nerve damage, or poor circulation.

The first step to home care is to soak your foot in a solution of Epsom salts and room temperature water. Then gently massage your nail to reduce inflammation. Don't cut your toenail and wear open shoes like sandals until the problem goes away.

Also, you may need to take a closer look at the fit and shape of your shoes and socks to see if they are the cause of your ongoing problem. This can mean that you have to choose between nice shoes and nice toes.

If your healthcare provider suspects an infection, you may need to take an antibiotic. Also, keep in mind that your healthcare provider may need to remove some or all of your toenail to relieve inflammation.

Toenail injury

Toenail bruise. Photosvit / Getty Images

Toenail injury can be chronic or as a result of an acute injury.

Symptoms of Toenail Injuries

Damage to the growth center or matrix of the nail can lead to a number of possible changes to the nail. Changes that can occur include blood and bruising under the toenail, thickening or loss of toenails.


Toenail injuries can result from repeated rubbing against shoes while walking or running. Your new shoes may be too tight or too loose, which can lead to more friction on your toes during training. It can also be the result of a sudden injury, such as a bruised toe or an object falling onto it.

Trauma to the toenail can lead to a secondary bacterial or fungal infection if any part of the nail comes off. This can lead to darkening of the toenail. Acute trauma can also result in a bone fracture under the nail, to which the nail is very close.

It is best to have a podiatrist or other health care provider evaluate any discoloration or loosening of the toenails. In some cases, although infrequently, a black or brown discoloration can be a sign of skin cancer melanoma.

Watch out

Surgical removal of a thick or damaged toenail will likely not result in a healthier toenail growing in its place. Once the nail growth center (nail matrix) is damaged, it usually continues to form a thickened or deformed nail.

Frequently asked questions

What makes the toenail black?

A subungual hematoma often causes darkening or blackening of the toenails. The entire nail or a small part of it may look black due to bleeding under the nail. Often the bruise heals on its own. However, sometimes the nail will fall off because of this. Sometimes a black nail can be caused by something more serious, like melanoma.

Why do toenail fungal infections keep coming back?

Some evidence suggests that certain people may have a genetic predisposition to fungal nail infections. Recurrent infections can also occur in people with weakened immune systems. They can also be a sign of diabetes , a condition in which the blood supply to the feet is cut off and it becomes more difficult for the body to fight fungus.

Get the word of drug information

If you have a problem with your toenail, you may be embarrassed by its appearance. Or you may worry that what's wrong with the toenail is a window into an underlying health condition that has yet to be diagnosed. Hopefully, this basic toenail knowledge will help ease your anxiety a bit and get you ready for your doctor's appointment.

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