Sophia Delgado
Healthy nails grow when cells multiply at the base of each nail and then layer on top of each other, hardening over time. This process is called keratinization, and it involves the same protein, keratin, that makes up our hair. However, sometimes nails can grow upward or on top of each other, which could indicate an underlying condition known as retronychia. Retronychia occurs when the nail plate grows into the nail fold, causing multiple layers of new nail plates to stack under the old nail plate. This condition is often caused by repetitive injury to the nail, such as wearing tight shoes, and it can be treated by addressing the underlying cause and ensuring proper nail care.
| Characteristics | Values |
|---|---|
| Condition | Retronychia |
| Cause | Repetitive injury to the nail, often caused by wearing tight shoes or activities that lead to toenail injury |
| Symptoms | Pain, inflammation of the nail fold, yellow or white discoloration of the nail plate, and growth of new connective tissue on inflamed areas |
| Treatment | Acute stage: Corticosteroids applied to or injected into the nail. Chronic stage: Removal of the nail |
| Prevention | Avoid activities that injure the nail, wear shoes with more space around the toes, keep toenails trimmed and dry, wear thick socks to cushion against friction, buy shoes with room for air movement, avoid harsh chemicals |
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What You'll Learn
Nail separation (onycholysis)
Onycholysis, or nail separation, is a common nail disorder in which the nail separates from the nail bed. It typically only affects one nail, but it can affect multiple nails in some cases. The condition is generally painless, but it can be cosmetically unacceptable, especially for those who work with their hands. Onycholysis can occur due to various reasons, including injuries, fungal infections, reactions to chemicals, and underlying medical conditions.
Injuries or trauma to the nail or the nail matrix (the area where nails start to grow) are common causes of onycholysis. Such injuries can occur from bumping or hitting nails, wearing shoes that are too tight, keeping nails in water for extended periods, or even regular manicures. Additionally, activities that put repetitive pressure on the nails, such as tapping nails on a hard surface, can lead to onycholysis.
Chemical exposure is another cause of nail separation. Certain chemicals in nail products like nail polish, nail gloss, nail hardeners, and nail polish removers can irritate the nails and lead to onycholysis. It is essential to be cautious with these products and consider using gloves when working with them.
Fungal infections are a common cause of onycholysis. Fungi can get between the nail and the nail bed through cracks or cuts in the fingers or toes. These infections cause the nails to thicken and turn yellow, and they may also show white spots and streaks. Oral and topical antifungal medications are often prescribed to treat fungal onycholysis.
Underlying medical conditions can also contribute to nail separation. For example, nail psoriasis changes the structure of the nail and can lead to onycholysis. Additionally, chemotherapy and certain medications that cause light sensitivity, such as tetracycline and nonsteroidal anti-inflammatory drugs (NSAIDs), have been linked to onycholysis. Iron deficiency and hyperthyroidism are other potential medical causes.
Treating onycholysis involves addressing the underlying cause. In many cases, the separated nail is cut away as it grows out, and new nail growth is encouraged to attach to the nail bed. Keeping nails trimmed short can help prevent onycholysis and reduce the risk of further separation. It is important to note that onycholysis can predispose individuals to secondary infections under the nail, so maintaining good nail hygiene and avoiding irritants are crucial during the healing process.
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Toenails growing upward
However, there are some possible causes for nails growing upward that are not hereditary. Your shoes could be pushing at the tips of your toenails, or your toenails could be affected by profuse foot sweat. Toenails growing upward could also be caused by depressed nail beds.
There are also some more complex medical explanations for toenails growing upward. Onychogryphosis, also known as ram's horn nail or claw nail, is a thickening of the nails due to injury or infection. It mostly affects the big toes and causes the nails to curve and resemble the shape of a ram's horn or claw. Nail patella syndrome (NPS) is a rare genetic disorder in which people often have thin and fragile nails that look concave or "scooped out," similar to a spoon.
If you notice that your toenails are growing upward, it is important to maintain proper toenail hygiene to prevent infection. Trim your toenails frequently using a strong, sharp nail clipper, cutting each toenail straight across to the point where it begins to curve upward. Leave the nail a little long to prevent it from growing inward. It is also important to keep your feet clean and dry, wear thick socks to cushion against friction, and buy shoes that fit properly and have plenty of room for air movement.
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Retronychia
To treat acute retronychia, corticosteroids are applied to or injected into the nail. In the chronic stage, the nail is removed, and patients are advised to avoid activities that injure the nail and to wear shoes with more space around the toes to relieve pressure on the affected toenail.
To prevent toenails from growing upward, it is important to maintain proper toenail hygiene. This includes trimming toenails with strong, sharp nail clippers to the point where they begin to curve upward, cutting them straight across without cutting the edges inward, and leaving them a little long to prevent them from growing inward. Inspecting toenails regularly, using a nail cleaner to remove dirt, and washing and drying the feet thoroughly are also important aspects of toenail care.
Additionally, wearing thick socks made of natural fibres can help cushion the toenails against friction from shoes and absorb sweat. Ensuring that shoes fit properly and have enough room for air movement can also help prevent toenails from growing upward. Avoiding harsh chemicals and maintaining good hygiene practices in public places, such as gyms and swimming pools, are other important considerations.
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Nail matrix damage
The nail matrix is the "factory" where new nails are made. It is located at the base of the nail and is responsible for creating new cells that allow nails to grow. The nail matrix has two parts: the germinal matrix and the sterile matrix. The germinal matrix contributes to about 90% of nail production, while the remaining 10% comes from the sterile matrix, which is also responsible for keeping the nail attached to the underlying skin.
Injuries and certain health conditions can damage the nail matrix and interfere with nail growth. Trauma to the nail matrix can cause the production of new nail cells to stop for up to three weeks, and severe cases may result in long-term or permanent effects. Nail growth will usually resume after about 100 days, but the nail may appear thicker than usual. Minor matrix damage can cause temporary changes in the nail's appearance, such as dents, horizontal ridges, pain, splits, spots, streaks, and texture changes. Severe injury to the nail matrix could cause the nail to fall off, and in rare cases, the nail may not grow back.
If you notice any changes to your nails, it is important to seek medical advice to determine the cause and receive appropriate treatment.
To prevent nail trauma and potential damage to the nail matrix, it is recommended to keep nails trimmed and maintained to minimize the chance of breakage. Wearing protective gloves during repetitive tasks or heavy lifting can also help prevent injuries. Additionally, wearing properly fitted shoes with room for air movement and thick socks that cushion against friction can help prevent toenail injuries.
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Nail fungus
Nails grow through a process called keratinization, where cells multiply at the base of each nail, layer on top of each other, harden, and eventually push through the skin. Toenails that grow upward are not uncommon and could be due to several reasons, including the natural growth pattern, tight shoes, profuse foot sweat, or more complex medical explanations.
One possible explanation for nails growing on top of each other could be a condition called retronychia, where the nail plate (the hard part of the nail made of keratin) grows into the nail fold. This can cause multiple layers of new nail plates to form under the old nail plate, giving the appearance of nails growing on top of each other.
Retronychia most often affects the big toenails and is caused by repetitive injury to the nail, such as wearing tight shoes or participating in activities that lead to toenail injuries. In the acute stage, retronychia can be treated with corticosteroids applied to or injected into the nail. In the chronic stage, the nail may need to be removed.
Another possible explanation for nails growing on top of each other could be a fungal nail infection, which can cause the nail to become thickened, discoloured, and distorted. Fungal infections occur when fungi get between the nail and the nail bed through cracks or cuts in the finger or toe. These infections can be difficult to treat and usually require oral or topical antifungal medications.
To prevent and manage nail issues, it is important to maintain proper nail hygiene, keep nails trimmed and smooth, and avoid biting them. Additionally, wearing properly fitting shoes and socks that absorb sweat can help reduce friction and moisture buildup, which can contribute to nail problems.
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Frequently asked questions
This condition is called retronychia, which occurs when the nail plate (the hard part of the nail made of the protein keratin) grows into the nail fold. Multiple generations of new nail plates can then grow on top of one another in a stack under the old nail plate because the nail matrix and the old nail plate are no longer aligned.
Retronychia is often caused by repetitive injury to the nail, such as wearing tight shoes or participating in activities that lead to toenail injury. It could also be caused by fungal infections, which cause nails to thicken and turn yellow, and show white spots and streaks.
In the acute stage, retronychia can be treated with corticosteroids that are applied to the nail or injected into the nail. In the chronic stage, the nail must be removed. To prevent retronychia, avoid activities that injure the nail and wear shoes with more space around the toes to relieve pressure on the affected toenail.
