Common Toenail Problems and How to Treat Them

Toenail problems can be painful and extremely frustrating to have, especially when blackened toenails, toenail fungus, and ingrown toenails are involved. But there are various preventative measures and treatments available to combat these foot conditions to restore nails back to health. Below we have included some of the most common toenail problems, their symptoms, and how to treat them.

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Black-and-Blue Toenails (Hematoma)

Unlike with yellow toenails, black-and-blue toenails are not actually caused by a change in the color of the nail enamel itself. Black-and-blue toenails are caused by an injury to the skin beneath the toenail. As blood and fluid collect beneath the nail plate the nail itself, which is somewhat translucent, begins to appear black. In athletes, black-and-blue toenails, often referred to as simply black toenails, are usually the result of wearing athletic shoes that do not have adequate space in the toebox causing the toes to repeatedly bang against the top, front, and sides of the shoe during physical exertion. This repetitive stress to the toe causes a blood blister to form beneath the toenail. The condition occurs most frequently among runners and soccer players because their toes are subjected to the roughest impact and the effect of toebox impact can be more pronounced in athletes who do not trim their toenails frequently enough. To prevent or decrease the discomfort of black toenails you may wish to switch to an athletic shoe with a roomier toebox.

If you're certain that improperly fitting athletic footwear is not causing the problem, the other common cause of black toenails is a sudden violent impact to the toe such as jamming your foot in a door or getting your toe smashed by a heavy object. In rare cases a toenail may appear black when no injury has occurred. You should then see a doctor immediately as this can be a symptom of melanoma (skin cancer).

Black-and-Blue Toenail Symptoms

The big toe is most often affected. Bruised, broken blood vessels cause the black, blue, and deep purple colors under the nail. Particularly with a blood blister, the fluid buildup can irritate the toe itself causing it to redden, swell, and throb. If the black toenail is the result of a blood blister the painful symptoms should decrease within 24 hours. If your toe remains painful and swollen there is a danger that it may have become infected and you should see a podiatrist. In fact, it's usually a good idea to see a podiatrist anyway as a precaution to rule out a toe fracture as the underlying cause of the damage. As the skin beneath toenail heals it is not uncommon for the toenail to become separated from the nail bed causing your toenail to fall off. If your black toenail falls off it usually takes about four or five months for the toenail to fully grow back.

Evaluating Black-and-Blue Toenails

Your podiatrist will talk with you about your symptoms and physical activities. He or she may palpate (press) the area at the end of the toe to determine the extent of pain. Your toe and foot are examined for any signs of infection. If a fracture or bone spur is suspected, x-rays may be needed. If small black spots are present under the nail, other problems may need to be ruled out.

Black-and-Blue Toenail Treatment

If pain is severe you should see a podiatrist immediately to determine whether your require treatment. A podiatrist may decide to remove the black toenail or to drill a hole in the nail to allow drainage and relieve the pressure. Pain may also be relieved with prescription medications, or by soaking or icing the area.

If pain is not severe, you probably won't need to see a podiatrist for treatment. The nail can be thinned or left alone to fall off. A new nail will grow in its place, but you may wish to reevaluate your athletic footwear choices to ensure that the problem does not reoccur. Some of the brands that have been podiatrist reviewed and recommended to prevent toe injuries while still promoting enhanced athletic performance are Brooks, New Balance, and Aetrex.

Thickened Toenails

The most common cause of abnormally thick or crumbling nails is toenail fungus. Thickened toenails can also be caused by toe injuries, pressure from shoes, and conditions such as diabetes, psoriasis, or vascular disease. If you have thickened toenails you should see a podiatrist to determine their underlying cause. Thickened toenails usually don't occur spontaneously. They are a symptom of another disease or foot condition or else they are a sign that excessive pressure is being placed on the toes. If left untreated, thickened toenails may loosen and fall off.

Thickened Toenail Symptoms

Along with thickening, the nail may appear ridged, brittle, or yellowish. The nail may also feel painful when pressure is put on it.

Evaluating Thickened Toenails

Since thickened nails may be a symptom of an underlying medical condition, it is important for your podiatrist to look at your medical history for possible related problems. To check for a fungal infection, a culture may be done. The thickness and color of the nail are also examined carefully to determine possible infections or other conditions.

Thickened Toenail Treatment

If the nail is not infected, your podiatrist may be able to thin it by trimming, filing, or grinding. If a topical antifungal cream may be needed. This can help prevent ulcerations under the nail while keeping the fungus from spreading to other nails. You may also wish to treat your shoes with an antifungal foot powder to kill the fungus inside the toebox. If pain is still present, the entire nail or part of it can be surgically removed. Do not remove the nail by yourself.

Ingrown Toenails

An ingrown nail is the result of a nail growing into the skin that surrounds it. This often occurs at either edge of the big toe. Ingrown nails may be caused by improper trimming, inherited nail deformities, injuries, fungal infections, or pressure.

Ingrown Toenail Symptoms

Ingrown toenails may cause pain at the tip of the toe or all the way to the base of the toe. The pain is often the worst while walking. An ingrown toenail may also lead to infection, inflammation, or a more serious condition. If the nail is infected, you might see pus or redness.

Evaluating Ingrown Toenails

To determine the extent of your problem, your podiatrist examines and possibly palpates (presses) the painful area. If other problems are suspected, blood tests, cultures, or x-rays may be done as well.

Ingrown Toenail Treatment

If the toenail isn't infected, your podiatrist may trim the corner of it to help relieve your symptoms. He or she may need to remove one side of your nail back to the cuticle. The base of the toenail is then treated with a chemical to keep the ingrown part from growing back. Severe infections or an ingrown nail may require antibiotics and temporary or permanent removal of a portion of the nail. To prevent pain, a local anesthetic may be used in these procedures. This treatment is usually done at your podiatrist's office. To find over-the-counter, medical quality products for treating ingrown toenails visit our ingrown toenails condition page.

Preventing Nail Problems

Many nail problems can be prevented by wearing healthy shoes and trimming your nails properly. To help avoid infection, keep your feet clean and dry. If you have diabetes, see a podiatrist at the first sign of foot injury. Diabetic feet are subject to an elevated risk of infection and complications from foot conditions.

Healthy Shoes Keep Nails Healthy

The shoes you wear have a much greater impact on the health of your nails than most people realize. The most basic step you can take to prevent nail problems is to always wear shoes that fit. Even if you think you know your shoe size, particularly if you have had nail or foot problems in the past, get your feet measured before buying a new shoe. Your shoe size can change as you age. Pay attention to how a shoe feels the moment you try it on. The idea that there should be a break-in period before a new shoe can be comfortable is a myth. A new shoe should be comfortable the moment it goes on your foot. If it isn't, return it and try another shoe.

Wear shoes that are supportive and roomy enough for you toes to wiggle. This serves two purposes. First, it prevents black toenails that occur when your toes are uncomfortably squished against the top and sides of your shoes. Second, it increases the circulation in your shoes keeping them fresh and dry. Moist, cramped shoes often become a breeding ground for bacteria increasing the likelihood of you contracting toenail fungus. You should also look for shoes made of natural materials, such as leather which allow your feet to breathe.

Proper Trimming

Ragged, overly long toenails catch on things, attract fungi and other bacteria, and increase the risk of damaging the entire toenail matrix if you have to stop suddenly while walking or running. To avoid problems trim your toenails regularly. Trimming them straight across without cutting down into the corners decreases the likelihood of ingrown toenails. If you can't trim your own nails, ask your podiatrist to do so for you.