
Long toenails can be bothersome and lead to various issues, from the merely annoying to the potentially serious. They can get caught on socks, shoes, and blankets, and when they do, they can break, leaving sharp edges that can cut your toes and feet. Long toenails can also press against the inside of your shoes, causing soreness and pain, especially with tight or ill-fitting footwear. They are more likely to become ingrown, where they grow into the surrounding skin, causing pain, redness, and infection if not addressed. Long toenails can also increase the risk of nail damage, such as breaking, splitting, or thickening, which can be painful and take a long time to heal. They also create a perfect environment for fungal and bacterial infections. To avoid these issues, it is essential to keep toenails trimmed to a hygienic length and cut straight across, not too short, and not rounded.
| Characteristics | Values |
|---|---|
| Long toenails in older adults | May indicate overall functional status and risk of frailty |
| Can cause pain, especially if thickened | |
| May be a result of difficulty in maintaining foot hygiene | |
| May be a sign of impaired cognition and decreased independence | |
| Toenail fungus | Common and contagious |
| Caused by a type of mold called a dermatophyte | |
| May cause changes in nail pigmentation and onycholysis | |
| Can be treated with oral antifungal medication |
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What You'll Learn

Long toenails can be a sign of frailty in older adults
The "long toenail sign" is significant because it provides insight into an older adult's ability to perform activities of daily living independently. For example, a 78-year-old male patient who had long and thickened toenails consistent with onychomycosis also presented with impaired cognition, difficulty in completing a chair stand, and a slow gait speed. His son was assisting him with grocery shopping and household chores, unaware of his father's difficulties in maintaining foot care.
Long toenails can also be a risk factor for falls in older adults. Foot pathologies, such as onychomycosis, onychoclavus, and ingrown toenails, can lead to impaired mobility and balance. Additionally, older adults with long toenails may experience foot pain due to bony deformities, ill-fitting footwear, or underlying conditions such as diabetes and neuropathy. These factors can further contribute to a decline in functional independence.
Therefore, examining the feet of older adults, including inspecting their toenails, is crucial for detecting remediable conditions and assessing their overall functional status. Healthcare providers can offer interventions such as foot care assistance, appropriate footwear, and treatment for fungal infections to improve their patients' quality of life and reduce the risk of frailty associated with long toenails.
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Thickened toenails can cause pain
Thickened toenails can be unsightly and uncomfortable, and in some cases, they can cause pain. While toenail thickening is usually not harmful, it can indicate an underlying issue that may require treatment.
Thickened toenails are often caused by a fungal infection, which can be treated with antifungal medications. Fungi thrive in warm, moist environments, and toenails are particularly susceptible because they are frequently exposed to wet areas. As the infection progresses, the toenails may become painful and make wearing shoes or walking difficult. In rare cases, toenail fungus can lead to a serious infection called cellulitis, which requires prompt medical attention.
In addition to fungal infections, thickened toenails can also result from mechanical stress, such as wearing poorly fitting shoes or participating in sports or exercises that involve repetitive microtrauma to the nails. Athletes, runners, and dancers are particularly prone to this type of nail injury, which can cause the nails to thicken and become curved and yellowed. Seeking medical treatment for nail injuries can help promote healthier nail growth.
Underlying medical conditions, such as autoimmune diseases like psoriasis, can also cause toenail thickening. Psoriasis can cause the nails to become thick, brittle, and weak, sometimes even leading to nail loss. Additionally, certain preexisting conditions, such as diabetes, cancer treatments, and immune system disorders, can increase the risk of developing toenail fungus, making it crucial to consult a healthcare professional for an accurate diagnosis and treatment plan.
While not always harmful, thickened toenails can be a source of discomfort and may indicate a more serious underlying condition. Practicing good foot hygiene, keeping the feet dry, and wearing properly fitting shoes can help prevent toenail thickening and reduce the risk of fungal infections.
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Toenail fungus is common and contagious
Toenail fungus, also known as onychomycosis or tinea unguium, is a common and contagious condition that affects the toenails. It is caused by a type of mold called a dermatophyte, which feeds on keratin, a protein found in nails that gives them hardness. While it typically affects the toenails, it can also spread to the fingernails.
Tinea unguium is the most common type of nail fungus, accounting for 90% of toenail fungal infections. It thrives in warm, moist, and dark environments and can be spread through direct contact or by touching infected surfaces. Walking barefoot in public areas, such as around swimming pools or in locker rooms, increases the risk of contracting this contagious infection.
The presence of toenail fungus can lead to thickened, discolored (usually yellow), and brittle nails that may show white spots and streaks. In some cases, the whole nail can break off, causing pain and swelling in the surrounding skin. While often asymptomatic, the infection can cause self-consciousness about the appearance of one's feet.
Toenail fungus is notoriously challenging to treat, and even with treatment, it tends to recur. Treatment options include oral antifungal medications, such as terbinafine (Lamisil®), itraconazole (Sporanox®), or fluconazole (Diflucan®), which must be taken daily for several months or longer. Good hygiene and foot care practices can reduce the likelihood of recurrence.
If you suspect you have toenail fungus, it is advisable to consult a healthcare provider, such as a dermatologist or podiatrist, who can guide you through the treatment options and help address any concerns you may have about your foot health.
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Foot hygiene is important to prevent infections
Long toenails can be bothersome and even lead to health issues. Foot hygiene is important to prevent infections and other foot-related problems. Here are some ways to maintain good foot hygiene and prevent infections:
Firstly, wash your feet daily with warm water and a mild soap. Use your hands or a soft cloth to gently lather and scrub your feet, avoiding harsh movements that can irritate the skin. Rinse well and gently pat your feet dry with a clean, soft towel. Keeping your feet clean and dry is crucial in preventing infections as bacteria and fungi thrive in warm, damp environments.
Trimming your toenails regularly is an important aspect of foot hygiene. Long toenails can be uncomfortable and lead to ingrown nails, which can cause pain and infection. Trim your nails straight across, avoiding cutting them too short or rounding the edges. Use clean, sanitized nail clippers or scissors to prevent infections and maintain neat nails.
Moisturizing your feet is also an essential step in foot hygiene. Dry, cracked skin can be uncomfortable and provide an entry point for infections. Use a good quality foot cream or lotion, focusing on the tops, soles, and especially the heels, which are prone to dryness. Avoid applying lotion between your toes as this can trap moisture and increase the risk of fungal growth.
Wearing the right footwear is key to maintaining foot hygiene and preventing infections. Opt for well-fitting, breathable shoes that provide adequate support for your arches and heels. Avoid tight or narrow shoes that can cause blisters, ingrown toenails, and structural issues. Give your shoes time to air out between uses, and consider using insoles designed to wick moisture away from your feet.
Lastly, socks play a vital role in foot hygiene. Choose socks made from moisture-wicking, breathable materials to reduce sweat buildup and control odors. Change your socks daily, or more frequently if they become damp, and wash them with hot water and detergent.
By following these steps and maintaining good foot hygiene, you can effectively prevent infections and maintain healthy, comfortable feet.
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Bony deformities can lead to ill-fitting shoes
Bony deformities can be exacerbated by ill-fitting shoes, which can cause further friction and pressure. For instance, shoes that are too narrow or short can place extra pressure on the toes, leading to ingrown toenails. Ingrown toenails occur when the edge of the nail grows into the skin, causing pain, redness, and potential infection. This is a common issue, with only 28-37% of people wearing shoes of the correct length and width.
Foot pain is a common symptom of ill-fitting shoes, which can lead to a decrease in overall foot health and even severe conditions like neuropathy and foot ulcers. Ill-fitting shoes can also cause corns and callouses, which are thickened skin areas caused by constant friction or pressure. In older adults, foot lesions can develop due to ill-fitting shoes, reducing mobility and independence.
Bunions, for example, are painful bony bumps that form at the base of the big toe when tight, narrow, or pointy shoes are worn. This causes the big toe to push against the next toe, leading to inflammation and pain. Similarly, hammertoe is a deformity where one or more toes are bent upward at the middle joint, often caused by shoes lacking a soft, expansive toe box.
To prevent these issues, it is important to ensure properly fitting shoes that are not too loose or tight around the toes. Shoes with a soft, expansive toe box made of materials like soft, expansive leather can help accommodate bony deformities and reduce pressure. It is recommended to measure feet at least once or twice a year and try on shoes at the end of the day when feet are most swollen to ensure a proper fit.
Additionally, toenail care is important to prevent issues such as toenail fungus, which thrives in environments with pressure and moisture commonly found in ill-fitting shoes. Trimming toenails straight across and practicing good hygiene and foot care can help reduce the risk of toenail fungus and other infections.
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Frequently asked questions
Yes, long toenails can be unhygienic as they are more susceptible to bacterial and fungal infections.
Yes, long toenails can cause pain and discomfort. They can press against the inside of your shoes, causing pressure on the nail bed. This can also lead to soreness, bruising, nail discolouration, and redness.
Yes, long toenails are more likely to become ingrown. Ingrown toenails are painful and can get infected if not addressed promptly.
It is recommended to cut your toenails every six to eight weeks. However, you should check your feet regularly to ensure your nails are not too long.

















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