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toenail conditions

Alternative Names
ingrown toenail, abnormal nails, black toe, runner's toe, toenail infection

Toenail conditions can stem from many different sources. The most common cause of toenail problems is fungal infection. Other causes are abnormal growth, trauma, and skin conditions such as psoriasis.

What is going on in the body?
Toenail conditions are usually recognised when a person has pain or odd sensations while walking or exercising.

What are the signs and symptoms of the condition?
Symptoms of toenail problems range from a dull, aching discomfort to a sharp, piercing pains. Sometimes the first symptoms of toenail problems are a feeling of swelling and burning near the nail and redness on the skin around the nail.

What are the causes and risks of the condition?
Different toenail conditions present different risks. These risks can range from chronic low-grade pain to life-threatening infection.

Fungal infections, bacterial infections, damage to the nail from injury and other illnesses within the body may cause nail problems. Skin conditions like psoriasis, which causes a flaking of the skin around the elbows and hairline, can first show up as thickened nails. Other possible causes include several rare dermatological problems.

What can be done to prevent the condition?
Prevention is based on good nail hygiene. Dirt and other foreign matter should not be allowed to build up underneath the nail. The feet should be kept very clean. Nails should be trimmed straight across. The corners of the nails should not be trimmed back. The reason is that as a person walks on the toes, the flesh under the nails is pushed upward. If the nails are trimmed back, the flesh can be pushed up into the nail, and cause a painful ingrowing toenail.

How is the condition diagnosed?
Most nail conditions are easily diagnosed by looking at the nail. A diagnosis of thickened and discoloured nails may be more difficult. Most of the time, nail conditions are the result of a fungal nail infection. Sometimes, nail conditions indicate an underlying disease. A doctor, a podiatrist, or foot specialist, can usually best diagnose nail conditions. A history and physical examination, and sometimes a biopsy, are done.

What are the long-term effects of the condition?
The most common long-term effect is pain with walking or exercise. The pain goes way when the nail condition clears up. In some cases, bacteria may infect a nail, and sepsis, or blood poisoning, may occur.

What are the treatments for the condition?
Treatment depends on the condition.

Nails that are bruised and have an underlying blood clot can be extremely painful. They often need to be drained. Because of the risk of an infection, this is usually best done by a doctor. Nails that have been injured and are loose can sometimes be taped in place. The new nail grows in behind the old nail, pushing it away from the nailbed. If the nailbed is too unstable, the nail may need to be trimmed or removed by a doctor.

Ingrown toenails can be trimmed and carefully lifted up to place cotton underneath. This allows the nail to grow out straight rather than into the flesh. If this is not enough, just the ingrown portion of the nail can be permanently removed. Local anaesthesia is used to numb the toe, and the ingrown portion of the nail is removed. The growth tissue underneath is killed with a chemical or by laser surgery.

If an ingrown nail has caused an infection, the person usually needs to take antibiotics. Sometimes the ingrown nail acts as a chronic source of irritation, and the infection can not be cleared until the nail is temporarily removed. If the nail has been a constant source of trouble, it may be permanently removed after the infection is over. It's very rare to permanently remove the whole nail for an ingrown nail. In some cases, the nail is curved like a tunnel because of an underlying bone spur. The bone spur is removed to allow the nail to grow back in a flatter shape.

Thickened nails that have suffered trauma, or are affected by psoriasis, can just be filed flat. There may be no way to treat these nails and still allow them to grow back in a more normal fashion. If simple filing and cutting of the nail do not work, then permanent removal of the whole nail should be considered. Non-fungal causes of nail thickening should be diagnosed and treated by a doctor or podiatrist.

What are the side effects of the treatments?
Side effects of these nail conditions usually involve pain with walking or exercise. Very thickened nails or ingrown nails can become infected.

What happens after treatment for the condition?
Once the nails have been treated, they will need to be trimmed regularly. Good nail hygiene is very important for these nails. A nail brush, a sturdy nail file, and clippers designed for the toenails are used to maintain good hygiene. A good podiatrist, a person skilled at trimming and cleaning nails, can often help.

Author: Bill O'Halloran, DPM
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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