What hurts?
Some possible conditions • Toenail Conditions
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Injury/Trauma -
Brittle Nails -
Pitting -
Beau’s Lines -
Thickening -
Fungal -
Ingrown
Some possible conditions • Toenail Conditions
Whenever there is pain to the toe, be it from stubbing the toe, or infection, the pain is caused by damage to soft tissue or bone, including the nail. Due to the clear colour of the nail, it is very easy to see some of the effects of such an injury. Bruising, bleeding, and even lifting of the nail can occur due to the damage it sustains.
Injury to the nail can result in many other conditions. Injury can disturb the nail root, causing temporary or permanent damage, and creating the change in the nail that grows forth from it. Thick, curled, subsequently fungal, or brittle nails are all varieties of the different outcomes that can occur from an injury.
Symptoms will vary based on the type of injury and how it damaged the nail or nail root. If it was a physically acute injury, such as from a sport, it will often be severe in nature, with bleeding present under the nail (hematoma), or part of the nail falling off (onycholysis). Blood will not have the usual red colour, but appear black or brown underneath the nail as it dries out.
Injury to the nail is most often mechanical in nature, where an object outside the body comes into forceful contact with the nail. This might be stubbing the toe on a table, sports injuries, or even just the buildup of stress from wearing tight or short shoes over the years. Other causes may be more microscopic in nature, where infections can cause the nail to be damaged at a more cellular level. Changes within the body, such as swelling from an autoimmune disease can put pressure on the root too, causing the matrix to mutate.
Treatment for such nail injuries are primarily healed with time. Even when the bones of the toe are fractured, they are often left alone. Not to say that there is nothing to do, we are still able to immobilize the toe or cushion it with dressings to protect it from further damage when the injury is still fresh and the nail is tender. When the nail has lifted, it is best to remove as much of the lifted nail as possible, as it is unlikely to reattach. Any loose nail provides a haven for fungus to grow, as it prefers dark and moist environments that the openings of loose nails create. The same will go for any discolouration or changes in shape to the nail. If the injury just occurred and more than 25% of the nail is discolored, it is wise to have it addressed by a Registered Chiropodist who can drain it or remove the nail if necessary to prevent infection. If it is an older injury, is best to let it grow out as much as possible, which can be as long as a year for an entirely new nail to grow.
Brittle nails may sound like a relatively insignificant problem, but the brittleness can cause various issues. Some may be concerned about the aesthetics of such a nail, as it can look visibly weaker. Even when it does not, the integrity and strength is weak to the point that it cracks and breaks easily, causing pain.
The nail will appear very weak, and this can present in a variety of ways. In terms of thickness, the nail can be thin and lose much of its integrity, causing it to break easily. The small chips and cracks that build up over time can cause it to be sharp, and easily snag on the fabric of socks, further breaking the nail and causing pain.
There are a numerous amount of factors that lead to the nail being weak enough to become brittle. This could be due to a lack of nutrition from diet, dehydration, or other conditions such as anemia, diabetes, Raynaud's phenomenon, or hypothyroidism. More common causes would be from simply too little or too much moisture. This is seen in people who are working long hours and stay in their footwear for too long, creating excessive amounts of sweat. The most common cause of brittle nails is simply aging, as age will amplify prior health issues that may have led to the condition in the first place.
The best way to treat the brittle nail is to address the cause. Often the hardest part is pinpointing which lifestyle aspect is affecting the health of the nail the most. For nails that are moist too often, it is best to reduce it by making changes to the footwear, or changing socks more regularly throughout the day to reduce sweat. If nutritional deficiency is the main cause, changes to the diet under the supervision of a licensed dietitian will be best. More serious factors will need specific attention from the respective specialist, such as an endocrinologist to address hypothyroidism.
Treatment of the nail itself is simple - by keeping it short with regular trimming, we prevent the buildup of chips, cracks and unevenness, so the nail is unable to snag on sock fabric, which is where painful symptoms occur.
Psoriatic, or pitting nails, are not a very common condition of toenails but are worthy to mention as many are affected by psoriasis. Pitting of the nails may be concerning at first to see, but they generally do not cause any major problems. As the name suggests, it is associated with the skin condition psoriasis. As the nails are made of the same component as skin (keratin), this is unsurprising that they would be affected by a dermatological condition. Psoriasis results in dry, scaly skin that may show up in patches, and this can appear at the nail as well, but underneath.
Psoriatic toenails can look dfferent depending on where on the nail it is occurring. If it occurs at the end of the nail, near the white distal edge, it will appear as if the nail is lifting and uneven, with the “white” spreading in to create an uneven “splotch.” The nail can even become loose as it lifts more. However, the psoriasis can start within the nail, forming in the central nail. This will usually look like a much more round circle or circles, and at times they may appear white, or resemble a complete indentation to look like a pit within the nail.
Psoriasis causes psoriatic or pitting toenails and itself is complex and not yet fully understood. It is believed to be a result of the autoimmune system attacking the skin cells to create the hallmark scaly plaques on the skin and subsequently under the nail. The causes are purported to be both genetic and environmental. People with a family history, and specifically the PSORS1 gene, are more likely to be afflicted by psoriasis in general. Some environmental factors include fungal elements that can cause the skin to be inflamed along with other irritants.
To treat the pitting nail, we must treat the underlying cause. However, we cannot directly treat the psoriatic skin with the nail on top. If already loose and lifted, it is best to remove as much of that nail as possible and apply creams to the affected area underneath. Steroid creams may be used, but very sparingly, and only short term due to their side effects. There are oral medications to reduce flare ups, but they often have side effects as well and are usually stronger.
Often, fungal nails and psoriatic nails can be mistaken for one another. If treatment for psoriatic nails are failing, it may be best to biopsy the toenail to determine if fungus is present.
Lifestyle changes can have positive outcomes on the skin condition, likely due to increased circulation and other factors such as hormone production when making such changes. This might include diet, exercise, or getting more sunlight. The autoimmune nature of psoriasis makes it difficult to treat and the subsequent pitting nails can be a challenge to remedy, aside from maintenance.
Beau’s lines are markings in the nail, uncommon to most people. They are horizontal lines, going from side-to-side on the nail plate, not to be confused with vertical lines, which can be a natural part of aging. Nails are not perfectly smooth, but Beau’s lines will have very deep grooves and ridges in the nail that are often the result of underlying problems. These might be due to simple injury, or the aftereffects of an infection, or sometimes due to a more serious problem, such as vascular disease. As they are asymptomatic, some people may not even notice them unless they look closely at their feet, but it is important to find out why they are there in the first place.
The lines themselves do not cause any harm or pain, as they are the by-product of underlying issues. The lines are horizontal, going from one side of the nail to the other. The line itself is extremely prominent and will have large indents and indurations directly to the shape of the nail, as opposed to simple colour changes underneath the nail. Aesthetically, they can be displeasing to some and that prompts them to seek answers.
There are several factors that can cause Beau’s lines to appear, but they are mostly rooted in the main mechanism of halting the normal growth of the nail, directly at the nail root. This could be due to injury in the area. Injury can be physical, such as stubbing the toe, or a direct trauma, such as an object falling onto the toe. Alternatively, there could have been a prior infection of the nail, or a loss of blood supply due to poor circulation from peripheral arterial disease. Other systemic conditions leading to these lines include diabetes, and they almost always appear in children with Kawasaki disease. Perhaps another more uncommon cause of the lines is a simple vitamin deficiency, specifically from zinc.
At this moment, there is no treatment to reverse Beau’s lines. What you are seeing from the lines are remnants of damage sustained long ago, and the damaged nail will simply have to grow out. Should the lines be too prominent, they can be filed down with tools by a Registered Chiropodist or Footcare Nurse, but even then there will still be faint lines remaining due to the indented nature of the injury. They should not be painful and not cause any issue other than be aesthetically displeasing. If the appearance is of concern, a short-term solution could be nail reconstruction by a clinical professional, but this should not be a long-term treatment option, due to the occlusion of the nail and risk of fungus. Although painless, the underlying causes of Beau’s lines will need to be investigated if they last long-term.
Onychauxis is a condition of the nails that causes them to be thick, to varying degrees. Some people may mistake this condition for fungal nails, as they can appear very similar, but they are different in many ways! Onychauxis is NOT infectious, and is mostly harmless. However, a high level of thickness can lead to many other conditions, including being more susceptible to fungal infection so be mindful. Some other conditions that onychauxis can lead to is an ingrown nail when the thickening causes pressure along the borders/nail edges, or even lifting of the nail off the nailbed due to its sheer weight.
The most notable concern you will have is the unaesthetic thickening of the nail. Usually not an issue itself, but it can be aesthetically displeasing. If left alone for long enough, it can become thick to the point of causing discomfort and pain. The colour of the nail can appear black, due to blood blisters from trauma that caused the thickening, or simply dark and cloudy as we can no longer see through the nail to the skintoned underside of the skin.
A relatively benign condition, onychauxis can be caused by a number of factors, but primarily it will be due to damage to the nail. The nail grows from the nail matrix, otherwise known as the “root” of the nail, where new nail is created. The damage can be caused by numerous methods, most commonly it can be a simple “stub” to the toe or dropping something on your toe. However, damage can be from other sources as well, such as fungus. This is where it is easy to mix up the two diagnoses. Additionally, wear and tear over the years causes trauma to the nail root, as we are active or wear shoes that don’t fit properly and the toenail can get progressively thicker. Aging and conditions such as Diabetes can also cause a thickening of the nail plate.
Once the nail root is damaged, there is unfortunately little way to reverse it. There are occasions when the nail can heal by itself, but currently no interventions exist to restore the nail root to it’s normal state prior to the damage. The best treatment is to manage it before it becomes a hindrance or causes pain and pressure with shoes. A Chiropodist or Footcare Nurse will be able to take down the thickness of the nail safely and effectively, while maintaining a desirable appearance as well. Wearing shoes that provide enough toebox space is also key to prevent further damage or pain or pressure.
Fungal toenails, also known as “onychomycosis,” can be an unsightly but common problem. A fungal toenail infection is suspected when you see some discoloration of a toenail. However, they can be commonly mistaken for other conditions, such as thick nails, peeling nails, or brittle nails. To confirm whether or not your toenail is infected with fungus, it is best to have it assessed by a medical professional. If it is fungal, treatment can take some time to fully get rid of the infection. Prior to and during treatment, be mindful of the possibility of spreading the fungus to other toes, or to other people’s feet in public settings as fungal infections are contagious.
The appearance of a fungal nail can vary, depending on severity and the length of its affliction. Most commonly, you may see some areas of discoloration of the toenail, either to a white or yellow-brown colour. However, as it progresses, the nail may start to become thick, even curling up or lifting off of the toe. Some of the hallmark signs of a toenail fungal infection are the nail’s brittleness and how easily a fungal nail can crumble. Perhaps the most obvious sign will be its odour. Feet may get sweaty and odorous at the end of a long day, but fungus will smell like spoiled eggs, as it eats away at the nail.
Fungus is a microorganism like bacteria, so it is contagious and too small to be seen without a microscope. By keeping proper foot hygiene, wearing water shoes, and not sharing shoes with others, you can avoid it as best as you can, but be wary of public and shared spaces or pedicure salons who do not sterilize equipment. For example, in hot tubs and saunas, the water/temperature is very warm and a perfect environment for fungus to thrive in.
Fungal toenails can be very tricky to get rid of, so it is best to see a dedicated footcare clinician, such as a Chiropodist or Footcare Nurse. There are ways to prevent infection from occurring, and as mentioned before, it is with optimal hygiene practices. Fungi grow in moist and dark environments, so your feet inside their socks and shoes can be the perfect breeding ground. Be sure to change your socks regularly and keep them dry, especially after showers or water-based activities. If you are active for most of the day, it can be good to change your socks even multiple times a day. Avoid salons without steam sterilization practices. Consider wearing white socks that can be regularly bleached and clean the family shower often.
Medications prescribed by your healthcare professional will work best, but sometimes people want to try something at home. There is some thought that remedies such as tea tree oil help.
More advanced treatment methods such as laser therapy, light therapy, and toenail removal are becoming much more prominent as well. Please check with your local BioPed clinic to see about availability of these modalities/services.
One of the most common problems in the foot are ingrown toenails, also coined as “pincer” or “incurvated” nails. They get their name from growing deep into the skin, or from their curved shape that might resemble pincers. In the medical community, ingrown toenails are referred to as “onychocryptosis.” Most people experience them at least once in their lifetime, and they can be quite painful. However, the symptoms can range from mild to severe. In some cases, they may only be a minor annoyance but when progressed or left untreated, they can be extremely painful and become infected.
The most obvious and common symptom is pain at the corners or along the edges of the toenail. Sometimes the toenail might not even appear ingrown, but it is simply painful to the touch, and can be mistaken for something else due to an otherwise normal appearance. When they get more severe, the ingrown toenail will be a lot more obvious, with redness and swelling of skin along the border of the nail. If left alone for too long, infection can set in and there may be a white/yellow pus, reddened tissue seemingly growing over the nail, and significantly more pain.
There are several different causes of ingrown nails. One common cause is cutting the toenails improperly. It is recommended to trim your nails straight across so that they do not grow into skin borders. When trimmed improperly, you can create a nail spike, which will dig into the skin as the nail continues to grow. The presence of ingrown toenails can also be dependent on activity, such as long hours on your feet, tight footwear, or even having flat feet. With flat feet, the arch can be lowered, causing the foot to roll onto the inside of the big toe and cause additional pressure on the nail borders. One of the most unfortunate causes of ingrown toenails is simply that it is genetic and they tend to grow that way naturally, either from birth, or damage to the nail bed.
The first step most people take when they have an ingrown toenail is to try and clip it out. However, the toe is the furthest part of the body that you can reach with your eyes and hands, so it can be difficult to see and maneuver around there. Improper “removal” can make the ingrown toenail even worse. It is best to see a professional, such as a Chiropodist or Footcare Nurse, before trying anything that can aggravate or infect the ingrowing nail. If an infection is already present, a Chiropodist can write a prescription for an antibiotic. There are a few home remedies that can be tried before coming in:
• Soaking the feet in epsom salts can reduce inflammation and prevent infection.
• Applying over-the-counter antibiotic cream (Polysporin) to keep the area clean.
• Packing cotton wisps (from a cotton ball) underneath the nail edge to relieve some pressure
