Sophia Delgado
Toenails grow from the nail matrix, which is the factory where your body makes new toenails and fingernails. The nail matrix is the active tissue (or germinal matrix) that generates cells, which harden as they move outward from the nail root to the nail plate. The nail plate, or nail body, is the hard, visible part of the nail, made of translucent keratin protein. Toenails grow about half as fast as fingernails, with toenails growing at an average rate of approximately 1.6 mm per month, while fingernails grow at an average rate of approximately 3.5 mm per month.
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What You'll Learn
The nail matrix and its role in toenail growth
The nail matrix is an essential structure in nail growth, responsible for creating new cells that form toenails and fingernails. It is the "factory" where the body manufactures nails, and it plays a critical role in maintaining nail health. Located beneath the nail, the nail matrix consists of active tissue known as the germinal matrix, which generates new cells, and the sterile matrix, which helps keep the nail attached to the underlying skin.
The matrix is a dynamic tissue that constantly produces new keratin, a tough, rigid protein that is the building block of nails. As the keratin cells are produced, they move outward from the nail root, hardening as they progress to form the nail plate, the visible hard nail area. This process causes the nail to grow forward, with new cells pushing the existing nail structure. Toenails are made of alpha-keratin, a type of keratin found in the claws, hooves, and horns of vertebrates.
The rate of toenail growth is slower than that of fingernails, with toenails growing about half as fast as fingernails. On average, toenails grow at a rate of approximately 1.6 mm per month, taking 12 to 18 months to regrow completely. Several factors influence the growth rate, including age, sex, season, exercise level, diet, and hereditary factors.
Maintaining healthy cuticles is important for protecting the nail matrix from infection. Cuticle care involves moisturizing and gently pushing back the cuticle with an orange wooden stick. Proper nail care, including regular trimming and filing, is also essential for nail health and can help prevent issues such as ingrown toenails.
Injuries, illnesses, and certain medications can damage the nail matrix and affect nail growth and appearance. Trauma to the toe, such as dropping something heavy, can injure the matrix, leading to bruising, ridges, or nail loss. Fungal infections, commonly caused by yeasts and molds, can also impact toenail health. In some cases, medical conditions or their treatments, such as chemotherapy, may temporarily affect the nail matrix, causing slow nail growth or changes in appearance. Proper medical care can help promote healthy nail growth and address these issues.
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Toenail growth rate
Toenails grow from the nail matrix, a "factory" where your body produces new nails. The nail matrix consists of the germinal matrix, which contributes to about 90% of nail growth, and the sterile matrix, which is responsible for the remaining 10% of nail cells and plays a crucial role in keeping the nail attached to the underlying skin.
Toenails grow at a slower rate than fingernails. On average, a healthy person's fingernails grow at a rate of approximately 3.47 mm per month, while toenails grow at a rate of about 1.62 mm per month. The growth rate varies across different fingers and toes, with the little fingernail growing slower than other fingernails, and the great toenail growing faster than the other toenails.
Several factors influence the growth rate of toenails. Age, nutrition, and season are key determinants, with slower growth observed in older individuals, those who are malnourished, or those in colder climates. Toenail growth can also be impacted by trauma to the nail bed, with increased forces on the nail bed potentially changing the rate of nail growth. Additionally, certain medical conditions, such as fungal infections, chemotherapy, and illnesses like heart attacks, COVID-19, or pneumonia, can affect toenail growth and cause abnormalities in the nails.
Ingrown toenails are a common condition where the nail grows into the surrounding skin. This can be caused by improper toenail trimming, ill-fitting shoes, toe injuries, or the shape of the toe. Treatment for ingrown toenails may involve lifting the edge of the nail, placing cotton or dental floss between the nail and the skin, using antibiotic cream, and wearing roomier shoes. In severe cases, a healthcare provider may need to perform a procedure called nail avulsion to surgically remove part or all of the affected toenail.
While toenails typically grow back after falling off, severe damage to the nail matrix can, in rare cases, lead to permanent nail loss. However, such cases are uncommon, and with proper medical care, healthy nail growth can often be restored.
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Toenail growth and health conditions
Toenails are made of a protein called keratin, which is also found in skin and hair. They serve to protect the tips of the toes and the underlying nail bed, to which they are firmly attached. Toenails grow at an average rate of 1.62mm per month, which is up to four times slower than fingernails. Toenail growth depends on its attachment to the nail bed and slows as we age.
Toenail problems are quite common due to the daily wear and tear they experience. They can be caused by friction from shoes, physical activity, heat and moisture, and certain health conditions. Toenail fungus, or onychomycosis, is a common condition, affecting about 10% of people, and half of all people over 70 develop this infection. It can cause the nail to thicken, discolour, crumble, and spread to other toenails and the surrounding skin. Fungi thrive in dark, damp environments, so people whose feet remain wet for extended periods are at a higher risk of toenail fungal infections.
Other toenail conditions include ingrown toenails, which occur when the nail grows into the skin next to it, causing pain, redness, and bleeding. This can be caused by wearing tight shoes or rounding off the edges of the nail instead of trimming them straight across. Toenails can also be affected by skin diseases such as eczema, psoriasis, lichen planus, or lupus, which can cause abnormalities such as pits, grooves, or crumbling nails.
Certain medications and illnesses can also affect toenail growth and appearance. Chemotherapy and other medications can cause Beau's lines (horizontal ridges), slow nail growth, Mees' lines (white bands), and nail colour changes. Serious illnesses like a heart attack, COVID-19, or pneumonia can interrupt nail growth and cause Beau's lines.
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Toenail injuries and their impact on growth
Toenail injuries are common and can have a significant impact on your life and mobility. They can occur in many ways, from stubbing your toe to dropping something heavy on your foot. Athletes, runners, and hikers are particularly prone to toenail injuries due to the repeated strain and constant pressure on their nails. This can result in "runner's toe," a condition where blood collects beneath the nail, causing a painful dark blue or black discoloration known as a subungual hematoma.
If you experience severe pain, excessive bleeding, or signs of infection such as pus, redness, or swelling, it is crucial to seek medical attention. In some cases, the injured nail may need to be removed to repair a deep tear with stitches. Left untreated, severe toenail injuries can even lead to toe amputation in rare cases. Proper treatment is essential to promote healing and nail regrowth, as severe damage to the area where the nail grows can result in permanent changes to the nail's shape or prevent it from growing back entirely.
Minor toenail injuries can often be cared for at home. If the bleeding can be stopped, the nail is still attached, and the injury covers less than a quarter of the nail, you may be able to manage the injury yourself. However, if blood under the toenail covers more than half of the nail area, it is important to seek medical help to drain the blood and relieve pressure. Leaving blood under the toenail can lead to infection, and proper drainage must occur within 48 hours before the blood clots.
Toenail injuries can also lead to fungal infections, which are often associated with ingrown toenails, nail trauma, or injuries to the nail bed. Fungal infections can cause the nail to become thick, cracked, or discolored, usually white, brown, or yellow. Antifungal treatments, often in pill form, are typically used to treat these infections. In some cases, the nail may need to be removed, or laser treatment may be required if standard treatments are ineffective.
Toenail injuries can have a range of impacts, from temporary changes in nail appearance to permanent nail loss. Proper and prompt treatment is crucial to ensure the best chance of recovery and to minimize the risk of long-term complications.
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Toenail infections and their causes
Toenails grow from the nail matrix, the site of new nail growth. The nail matrix is located under the base of the nail, with the sterile matrix underneath the nail. The health of the cuticle, the small bit of thin skin on top of the nail, is important for protecting the matrix from infection.
Toenail infections are common, especially in people with diabetes or a weakened immune system. Toenail infections can be bacterial or fungal. Bacterial infections are normally caused by cutting the nail too short or cutting the cuticle. Ingrown toenails, which occur when the side of the nail grows into the skin, can also cause bacterial infections.
Fungal infections, meanwhile, can be picked up by walking barefoot in common areas like gym showers or locker rooms. Toenail fungus may appear as thick, yellow, cracked or cloudy nails. It can also cause the nail to become white, crumble, or break easily. Toenail fungus is unlikely to get better without treatment, and treatment can take a long time and sometimes causes side effects. Antifungal pills or creams can be used to treat toenail fungus, and in some cases, part or all of the affected nail may need to be removed.
Other causes of toenail infections include physical trauma, such as pinching or crushing the toe, and certain medications, such as chemotherapy. Toenail infections can also be caused by frequent exposure to water, such as from swimming.
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Frequently asked questions
Toenails grow from the nail matrix, the actively growing tissue below the nail bed.
The nail matrix is the "factory" where your body makes new toenails and fingernails. It produces new keratin that gathers at the nail plate and slowly pushes the nail forward, causing it to grow.
The nail bed is the tissue beneath the nail and contains nerves, lymph, and blood vessels. As the nail root grows, the nail moves down along the nail bed and adds material to its underside to make it thicker.
The nail plate, sometimes referred to as the nail body, is the hard nail area from the nail root to the free edge. It is made of translucent keratin protein.
Keratin is a tough, rigid protein found in nails, hair, and skin that works to protect against infection.
