Sophia Delgado
Fingernails and toenails are made from keratin, a protein that also makes up our skin and hair. They protect the soft tissues beneath them and are prone to damage due to their location at the tips of our fingers and toes. Nails can be injured in various ways, such as blunt trauma, cuts, or repeated trauma from ill-fitting shoes. When a nail is damaged, it can be painful and lead to infections. In some cases, the nail may fall off or need to be removed. Fortunately, nails typically regrow within 3 to 6 months for fingernails and up to 18 months for toenails, depending on various factors. However, if the nail matrix, the root of the nail, is severely damaged, there may be permanent deformities in the regrown nail.
| Characteristics | Values |
|---|---|
| Nail regrowth after injury | Nails can regrow after being injured, with the rate of regrowth depending on the severity of the injury |
| Nail matrix damage | If the nail matrix is damaged, the nail may not grow back or may grow back deformed |
| Treatment | In some cases, a doctor may need to remove the nail and repair the nail bed. OTC anti-inflammatory drugs can be used to relieve pain |
| Time to regrow | Nails typically take 3-6 months to regrow, with toenails taking longer than fingernails. In some cases, it can take up to 2 years for a toenail to regrow |
| Preventing nail injuries | Wear proper footwear, especially when playing sports or working with heavy objects |
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What You'll Learn
Nail injuries and how they can cause nail loss
Fingernails and toenails are prone to damage due to their position at the back of our fingertips and toes. Nail injuries can range from a bruise under the nail to the nail completely separating from the nail bed. Repeated trauma to toenails, caused by ill-fitting shoes, can lead to deformities in the nails. Longer nails are also more likely to become damaged as they can be levered off the nail bed.
A fingernail or toenail injury can be caused by a blow to the nail, or by closing a finger or toe in a door or drawer. This kind of trauma commonly results in blood under the nail, called a subungual hematoma. Nails can also be accidentally torn or split, or a splinter can get under the nail. Habits such as nail biting and cuticle biting can also cause trauma to the nails. Nail biting is a leading cause of acute paronychia, a type of infection where bacteria get under the tissue at the side of the nail, causing swelling and irritation.
Injuries to the nail can be complex wounds to repair. Permanent deformity to the nail can result, even after proper repair. If the nail matrix is not damaged, the nail is typically capable of regrowth. However, if there is damage to the nail matrix, the growing nail plate will contain a defect. Minor damage will produce minor defects in the nail, while more significant defects can result in a permanently deformed nail.
If the nail is torn or jagged, it should be trimmed to avoid snagging it on things and causing further injury. If the nail lifts completely off the nail bed, it may be most comfortable to initially replace the nail and hold it in place with a bandage. Nails will not reattach themselves to the nail bed after they have separated from it, but in most cases, a new nail will slowly regrow.
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The nail matrix and its role in nail growth
The nail matrix is a critical structure in the nail unit, responsible for nail growth. It is the "factory" where new nail plate cells are created, and as these cells are produced, older cells are pushed forward, and the nail plate grows. The nail matrix is made up of special cells that produce 196 layers of cells to form each fingernail or toenail.
The nail matrix is located at the base of the nail, and it is responsible for creating new skin cells, which push out the old, dead skin cells, facilitating nail growth. The lunula, the white crescent shape at the base of the nail, is the only visible part of the nail matrix. However, some people may not have visible lunulas, which is also normal.
The size and shape of the nail matrix determine the characteristics of the nail, including its thickness, width, and shape. A longer nail matrix will result in a thicker nail, while a smaller matrix will lead to a thinner nail. The shape of the matrix also influences the curvature of the nail, with a flatter matrix producing a flatter nail and a more curved matrix resulting in a deeper C curve in the nail plate.
Injuries, certain health conditions, and medications can damage the nail matrix and interfere with nail growth. Minor damage may cause temporary changes in the nail's appearance, such as dents, horizontal ridges, pain, splits, or colour changes. Severe injuries may cause the nail to fall off, and in cases of significant matrix damage, the nail may not grow back.
It is important to maintain the health of the nail matrix to ensure optimal nail growth and prevent potential damage. This includes practising good nail hygiene, avoiding excessive pressure or trauma to the matrix area, and maintaining a well-balanced diet for strong and resilient nails.
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Nail bed injuries and their treatment
Fingernails and toenails can be injured by a blow to the nail, by trapping the finger or toe in a door or drawer, or by dropping something heavy on the finger or toe. This kind of trauma commonly results in blood under the nail, known as a subungual hematoma. Nails can also be accidentally torn or split, or a splinter can get under the nail. Longer nails are more prone to damage as they can be levered off the nail bed or run into the end of an athletic shoe.
If the nail is torn or jagged, it should be trimmed to avoid further injury. If the nail lifts completely off the nail bed, it may be most comfortable to replace the nail and hold it in place with a bandage. Nails will not reattach to the nail bed after they have separated from it, but a new nail will usually regrow slowly. If blood occupies more than half of the nail area, a physician should be consulted, as it could indicate a bone fracture or tissue tear.
If the nail matrix is injured, the nail may fall off. The nail matrix is the "factory" where the body makes new nails. Certain injuries and illnesses can damage the nail matrix and affect how the nails look or grow. However, with the right treatment, healthy nails can often grow back. It may take several weeks for the new nail to appear. In cases of severe nail matrix damage, some or all of the nail may not grow back, and the nail may be permanently deformed.
Nail bed injuries are common, with fingertip injuries being the most common type of hand injury. Most nail bed injuries are caused by crushing, such as with a hammer or a car door. Crush injuries squeeze the soft tissue of the nail bed between the nail and the distal phalanx. This can result in a simple subungual hematoma or a laceration. Saws, knives, drills, moving belts, and lawnmowers are also common causes of nail bed injuries. Bandages and ice packs can help treat these injuries. Prompt treatment can help the nail bed and underlying structures heal and ensure that the nail grows back smoothly. Antibiotics may be required to prevent infection.
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Factors that affect the speed of nail regrowth
Fingernails grow at a rate of 0.13 inches per month, while toenails grow at almost half that rate. It takes 3-6 months for fingernails to regrow completely, and 12-18 months for toenails.
Several factors influence the speed of nail regrowth. Here are the key factors:
- Age and Sex: Nail growth slows down with age. Additionally, hormonal changes, such as those during puberty, pregnancy, and lactation, can affect nail growth rates.
- Health Conditions: Certain medical conditions can slow down nail growth. For example, people who are immunocompromised, paralyzed, malnourished, or have infections tend to experience slower nail growth. Chronic illnesses, such as thyroid disease, hypopituitarism, diabetes, and osteoporosis, can also lead to fragile and slow-growing nails.
- Medications: Chemotherapy and certain medications can temporarily affect the nail matrix, causing slow nail growth.
- Nutrition: Nutritional deficiencies can impact nail growth. Maintaining a nutritious and well-balanced diet is essential for supporting nail health and growth.
- Trauma and Injury: Nails on the dominant hand tend to grow faster due to increased use and a higher risk of trauma. When trauma occurs, the body sends more blood and nutrients to the area, promoting healing and potentially speeding up nail growth.
- Genetics and Hereditary Factors: Genetic factors can influence nail growth rates, and these vary from person to person.
- Season and Environment: Seasonal changes and environmental factors can also impact nail growth, although the specific mechanisms are not mentioned in the sources.
- Nail Hygiene and Care: Practicing good nail hygiene, including keeping nails clean, dry, and trimmed, can promote nail health and growth. Avoiding nail-biting and picking habits is also crucial for maintaining healthy and faster-growing nails.
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Conditions that can cause nail loss
A nail falling off is usually the result of trauma or injury to the nail or nail bed. This could be caused by a blow to the nail, dropping something on the toe, or even keeping nails in water for too long. In most cases, the nail will grow back, but this depends on the nail matrix, the area where new nail growth begins. If the nail matrix is damaged, the new nail may be deformed.
There are several conditions that can cause nail loss or affect nail growth:
Onycholysis
Onycholysis is the medical term for when a nail separates from its nail bed. It typically only affects one nail and can last several months or over a year. It is usually not painful but can be contagious if caused by a fungal infection. It can also be caused by injury or trauma to the nail, or a reaction to chemicals in nail products. Treatment focuses on new nail growth and keeping the nail attached to the nail bed.
Peripheral Artery Disease (PAD)
PAD causes reduced blood flow to the legs and feet, which can slow nail growth.
Skin Conditions
Certain skin conditions can affect the nail matrix and interfere with nail growth. These include:
- Eczema: Can cause Beau's lines (horizontal ridges in the nails), pitting, and texture or colour changes.
- Psoriasis: Can cause white lines, pitting, and crumbling of the nails.
- Subungual melanoma: A type of skin cancer that affects the nail matrix and causes brown or black discolouration of the nail.
Medical Treatments
Some medications and medical treatments can affect nail growth, including:
- Chemotherapy
- Antibiotics
- Anti-malarial medications
Other Conditions
Other conditions that can cause nail loss include:
- Nail infections, such as Tinea, a fungal infection that affects the toenails more than fingernails.
- Lichen planus infection, which causes the nail plate to split or layer as it grows.
- Ingrown toenails, which are often caused by wearing tight shoes.
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Frequently asked questions
It depends on the type of injury. In some cases, there may be pain and swelling, which can be treated with over-the-counter painkillers.
It can take anywhere from 4 to 18 months for fingernails to grow back, and 6 to 18 months for toenails.
If your nail falls off, you should ensure that your tetanus vaccination is up-to-date and keep the area clean and dry. Seek medical attention if there is any sign of infection.
A growing nail may have grooves, ridges, or bumps, and it may be misshapen.
Serious illnesses, certain medications, and skin conditions can affect nail growth. Peripheral artery disease, for example, reduces blood flow to the nails, slowing growth.
