Noah Sinclair
Toenails are meant to grow straight outward from the nail bed, protecting the ends of the toes. However, sometimes they grow sideways and into the skin, a condition known as an ingrown toenail. Ingrown toenails can be caused by several factors, including stubbing your toe, wearing ill-fitting shoes, cutting your toenails too short, or genetics. They can be treated at home if the pain is mild and manageable, but more severe cases may require professional treatment or even surgery. Onychogryphosis, or Ram's Horn Nails, is another condition where toenails grow unusually and thicken, curve, and resemble a ram's horn or claw. It can be caused by injury, infection, or underlying conditions such as peripheral vascular disease. Treatment options include steroid injections, antifungal medication, and, in some cases, surgery.
| Characteristics | Values |
|---|---|
| Toenails growing crooked | Could be the natural growth pattern |
| Could be genetic | |
| Could be caused by shoes that are too tight | |
| Could be caused by profuse foot sweat | |
| Could be caused by cutting toenails too short | |
| Could be caused by cutting toenails on a curve instead of straight across | |
| Could be caused by toenail trauma | |
| Treatment | Wear properly-sized shoes |
| Cut toenails straight across | |
| Use splints and pads to train the toes and nails to grow normally | |
| Steroid injections in the nail beds | |
| Antifungal medication | |
| Surgery | |
| Soak feet in a warm bath for at least 20 minutes | |
| Lift the ingrown nail out of the skin with a clean and sanitized nail care tool | |
| Place cotton or gauze under the nail to alleviate pressure and encourage healing | |
| Apply an over-the-counter antibiotic ointment to the surrounding skin |
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What You'll Learn
Toenails can grow crooked due to genetics
Toenails growing crooked can be attributed to several factors, and in some cases, it may be a combination of these. One of the most common causes of crooked toenails is improper trimming. If you cut your nails following the lopsided line where the nail bed separates from the nail, your nails may appear crooked. The solution here is simple: cut your nails straight across, and they will grow straight.
However, in some cases, toenails can grow crooked due to genetics. Nail Patella Syndrome (NPS) is a genetic disorder that affects 1 in 50,000 people. People with NPS often experience skeletal abnormalities involving the knees, elbows, and hips, and they are also prone to developing kidney disease. Almost everyone with NPS has nail abnormalities, and while fingernails are more commonly affected, toenails can also grow abnormally. NPS causes nails to become thin and fragile, taking on a concave or "scooped out" appearance, similar to a spoon.
Another rare genetic disease that can cause toenails to grow abnormally is Tuberous Sclerosis Complex (TSC). TSC causes benign tumours to grow throughout the body and is typically diagnosed due to the associated skin problems, including nail deformities. While the nail deformities may resolve in some cases, they can also worsen over time, sometimes turning into ram's horn nails.
Additionally, peripheral vascular disease, or peripheral artery disease (PAD), can cause unusual nail growth. PAD leads to a build-up of plaque in the arteries of the legs, reducing blood flow to the legs and feet. This condition can result in sores on the legs or feet and slow or unusual nail growth. While PAD is not always genetic, it does have a genetic component, as certain genes increase the likelihood of developing it.
Furthermore, nail clubbing, which refers to changes under and around the toenails that cause the toes to take on a widened, club-like appearance, can be an inherited trait. Nail clubbing is most often caused by underlying medical conditions, such as heart disease, lung disease, gastrointestinal disorders, or cancer.
While less common, ichthyosis, a rare genetic skin condition, can also lead to thickened or deformed nails. This condition is usually diagnosed at birth and is characterised by the presence of a collodion membrane on the skin.
If you believe your toenails are growing crooked due to genetic factors, it is important to consult a doctor or a medical professional for a proper diagnosis and guidance on management or treatment options.
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Wearing ill-fitting shoes can cause toenails to grow sideways
Toenails that grow sideways or upward can be caused by a variety of factors, including ill-fitting shoes, genetics, foot shape, and medical conditions. While it is not the only cause, wearing ill-fitting shoes can indeed play a significant role in causing toenails to grow sideways.
When shoes have a narrow or constricting toe box, it can lead to cramped toes. This lack of space causes the toes to overlap or press against the sides of the shoes, resulting in constant pressure and friction. The force exerted on the toes can cause the toenails to grow sideways into the surrounding skin, leading to painful ingrown toenails.
High heels are particularly problematic as they push the toes forward, amplifying the risk of ingrown toenails. The material of the shoe also matters—rigid and non-breathable materials can exacerbate pressure points and create a damp environment, making the skin more vulnerable to ingrowths. Additionally, loose-fitting shoes can be just as detrimental as tight ones. When the toes are repeatedly slammed against the front of the shoe, it can cause trauma to the nail, resulting in incorrect nail growth.
To prevent toenails from growing sideways, it is crucial to wear properly fitting shoes with a roomy toe box. This allows the toes to lie flat, wiggle freely, and breathe, reducing the risk of ingrown toenails. It is recommended to have your feet measured periodically as foot size and shape can change over time due to factors such as age, weight fluctuations, or life events like pregnancy.
In addition to wearing well-fitting shoes, maintaining proper nail care is essential. Cutting your toenails straight across can help encourage them to grow straight. Keeping your toenails trimmed and filing them with an emery board can also help prevent issues. Good hygiene practices, such as keeping your feet clean and dry, are crucial in maintaining overall foot health and preventing infections, especially with upward-growing toenails, which tend to rip more easily.
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Toenails can grow into the skin due to poor trimming
Toenails can grow into the skin due to several factors, including poor trimming techniques, ill-fitting shoes, foot shape, and genetic predispositions. Ingrown toenails, as they are called, are a common condition affecting the big toe, although they can occur on other toes as well.
Poor trimming is a leading cause of ingrown toenails. When trimming toenails, it is essential to cut them straight across rather than rounding or tapering the corners. Cutting nails in a curved shape can cause the nail to curve and grow into the skin. Therefore, it is recommended to use a sharp nail clipper to cut nails straight across, following the natural line of the nail bed. Filing the nails with an emery board after cutting can help smooth out any sharp edges and prevent them from catching on socks or other surfaces.
Additionally, wearing ill-fitting shoes that put pressure on the toes can contribute to ingrown toenails. Shoes that are too tight or narrow can push on the toenails, causing them to grow into the skin. Foot shape can also play a role, as some people's toenails may naturally curve downward due to the shape of their toes. In these cases, ensuring proper footwear that provides adequate space for the toes can help prevent ingrown toenails.
Furthermore, ingrown toenails can be hereditary. Some people are genetically predisposed to developing ingrown toenails, and this tendency can run in families. Nail patella syndrome (NPS), for example, is a rare genetic disorder that often includes nail abnormalities, although it typically affects fingernails more than toenails.
To prevent ingrown toenails, it is essential to practice good foot hygiene and care. Keeping the feet clean and dry, trimming nails regularly, and wearing comfortable shoes that fit properly can help reduce the risk of ingrown toenails. Soaking the feet in warm water before trimming nails can also make them softer and easier to cut. If ingrown toenails become infected or cause severe pain, it is important to seek medical attention. Treatment options include partial or complete nail removal surgery, although most cases of ingrown toenails can be managed through proper foot care and hygiene.
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Onychogryphosis, a nail disease, can cause toenails to thicken and curve
Toenails that grow upward and thicken are not uncommon. This could be due to the natural growth pattern of the toenail, or it could be that your shoes are pushing against the tips of your toenails. In some cases, toenails may thicken and grow upward as a result of profuse foot sweat or a more complex medical issue.
Onychogryphosis is a nail disease that causes toenails to thicken and curve. It is also known as ram's horn nails or claw nails due to the resemblance of the nails to the shape of a ram's horn or a claw. This condition is often associated with slow nail plate growth and is characterised by an opaque, yellow-brown thickening of the nail plate with elongation and increased curvature. The exact cause of onychogryphosis is not known, but it is believed to be related to poor peripheral circulation, which may be caused by diabetes mellitus. It is also associated with skin diseases such as ichthyosis, psoriasis, and pemphigus. Onychogryphosis mostly affects the big toes and is more common in older people, those with poor personal care, and patients with senile dementia.
The condition can develop at any age and tends to worsen over time. Repeated minor trauma to the toes and nail plates, such as from wearing ill-fitting shoes, can lead to onychogryphosis. Underlying conditions such as hammer toe and tuberous sclerosis complex (TSC) can also contribute to the development of this nail disease. If left untreated, onychogryphosis can cause pain and secondary complications, making it difficult to walk and perform daily activities.
If you suspect you have onychogryphosis, it is important to seek medical advice. Treatment options may include conservative management by limiting pressure on the nail bed, or definitive treatment through surgical procedures such as nail avulsion, matricectomy, or surgical resection of the nail matrix. In some cases, surgery may be necessary to remove the affected nail plate permanently.
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Peripheral artery disease can cause unusual nail growth
Toenails that grow crooked can be attributed to several factors. While it is natural for some people's toenails to grow upward, others may experience unusual nail growth due to peripheral artery disease (PAD). PAD is a common condition, particularly among the elderly, that affects blood circulation in the arteries leading to the legs and feet. This reduced circulation can cause toenails to stop growing or grow abnormally.
Onychodystrophy, a deformity of the nail plate, has been identified as a possible marker for PAD. Nail abnormalities, such as onychogryphosis or "ram's horn nails," can be caused by fungal infections or underlying conditions like hammer toe. In some cases, toenails may grow upward due to profuse foot sweat, shoe pressure, or more complex medical issues.
Additionally, PAD can cause injuries to the toenails to heal more slowly or not at all due to poor circulation. If left untreated, wounds can lead to tissue death and gangrene. This can further impact nail growth and overall foot health.
It is important to note that nail evaluations are a simple and accessible way to detect early signs of PAD. Onychodystrophy, as a possible marker for PAD, can be easily assessed through visual inspection of the toenails. If you suspect that peripheral artery disease is affecting your toenail growth, it is recommended to consult a vascular doctor for further evaluation and potential treatment options.
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Frequently asked questions
Toenails can grow crooked for a variety of reasons, including injury, trimming them too short, wearing ill-fitting shoes, and genetics.
You can try cutting your toenails straight across to encourage them to grow straight. Soaking your feet in warm water or Epsom salt water can also help to soften the nails and skin, making them easier to manage.
Crooked or ingrown toenails can lead to pain, swelling, and infection if left untreated.
If you are experiencing severe pain, infection, or if home treatments are ineffective, it is recommended to consult a doctor or podiatrist for professional treatment.
