Liam Carter
Have you ever noticed a secondary toenail growing beneath an existing one? This condition, known as retronychia, occurs when the nail plate grows backward instead of forward due to trauma or repetitive pressure, causing irritation and inflammation. In some cases, it may be the result of a toenail growing beyond the end of the toe, creating space for another nail to form underneath. While not a common occurrence, retronychia can lead to discomfort, discoloration, and even infection, requiring medical attention and, in severe cases, surgical intervention. Understanding the underlying causes of retronychia is crucial to prevent recurrence and ensure proper nail health.
| Characteristics | Values |
|---|---|
| Condition | Retronychia |
| Cause | Trauma or injury to the toe or nail plate, including dropping a heavy item on the toe, wearing ill-fitting shoes, or participating in repetitive activities like dancing or jogging. |
| Symptoms | Pain, inflammation, nail fold lifting, discoloration (yellow or white), thickened nail, separation from nail bed, missing cuticle, swollen/red/tender tissue around the nail, bacterial infection. |
| Treatment | Antibiotics, corticosteroids, nail trephination (for bruise under the nail), nail removal, filing the nail to reduce thickness, addressing the cause (e.g., changing footwear). |
| Prevention | Wearing properly fitted shoes with a deep toe box, trimming toenails straight across. |
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What You'll Learn
Trauma and injury
Retronychia is often caused by direct impact or trauma to the toe and nail plate, such as dropping a heavy item on the toe. It can also be caused by repeated micro-trauma from ill-fitting shoes or repetitive activities like dancing, jogging, or wearing tight shoes. Patients with systemic conditions such as arthritis and thrombophlebitis have also reported cases of retronychia.
In the acute stage, retronychia presents with pain, inflammation of the nail fold, white or yellow discoloration of the nail plate (xanthonychia), and the growth of new connective tissue on inflamed areas (granulation tissue). During this stage, treatment options include corticosteroids applied to or injected into the nail. If left untreated, the condition can progress to the chronic stage, where the inflammation resolves, but the nail plate thickens and separates from the nail bed, leading to stacked layers of nail plates and a missing cuticle.
To prevent retronychia, it is important to address the underlying cause. This may involve wearing properly fitted shoes with a deep enough toe box to prevent pressure and trauma to the toes and nails. Cutting nails properly, such as trimming toenails straight across, can also help prevent ingrown toenails and reduce the risk of retronychia.
In some cases, medical intervention may be necessary to treat retronychia. Antibiotics are not effective in resolving the condition, and surgical removal of the affected nail plate is often required to eliminate the source of irritation. After the nail is removed, the nail bed is allowed to heal, and a single new plate is encouraged to grow forward.
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Ill-fitting shoes
Fungal infections, such as onychomycosis, can also occur due to ill-fitting shoes. Fungi can overgrow in, under, or on the nail, leading to discolouration, thickening, and brittleness of the nail. Ill-fitting shoes create a warm, moist environment that promotes the growth of fungi. Additionally, excessive sweat inside socks and shoes can increase the risk of fungal infections. Wearing clean, absorbent socks and breathable shoes can help prevent these infections.
To prevent toenail problems caused by ill-fitting shoes, it is important to wear shoes with a deep enough toe box that allows the toes to splay out naturally when weight-bearing. Shoes should also have enough room at the end to accommodate the toes without pressing on them. Custom-made insoles or orthotics can also help distribute weight evenly and correct gait imbalances caused by ill-fitting shoes.
If you are experiencing toenail problems due to ill-fitting shoes, it is recommended to seek professional advice from a podiatrist or a healthcare provider. They can provide guidance on proper footwear, nail care, and treatment options such as antifungal medications or conservative treatments like taping and topical steroids.
Overall, ill-fitting shoes can have significant impacts on toenail health, and it is crucial to ensure that shoes fit properly and provide adequate comfort and protection to the toes and toenails.
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Skin conditions
The skin under the fingernail is called the hyponychium. It acts as a barrier to protect your nail from germs and debris. The skin in this region contains white blood cells to help prevent infection. However, sometimes the hyponychium can overgrow and become thicker, which can be painful and may increase the risk of infection.
There are several possible reasons why the skin under the nail grows and thickens. One possible cause is psoriasis, a skin condition where skin cells grow too quickly. It can affect any part of the body, including the nails. In the hyponychium and nail bed, the skin cells grow excessively, causing scaling and buildup. This overgrowth is called subungual hyperkeratosis.
Another possible cause of skin overgrowth under the nail is a fungal nail infection, also known as onychomycosis. This occurs when a fungus infects the skin and spreads to the fingernail. It can thicken both the nail and the skin tissue beneath it.
Additionally, certain skin conditions and diseases can affect your nail matrix, the area responsible for nail growth, and interfere with nail growth. Here are some skin conditions that can affect your nails:
- Eczema: Severe eczema can affect your nail matrix and temporarily slow down or stop nail growth. You may observe Beau's lines (horizontal ridges), pitting (small, pinhole-like dots), and changes in texture or colour.
- Psoriasis: Up to 80% of people with psoriasis develop nail psoriasis. It can cause white lines, pitting, and crumbling of the nails.
- Subungual melanoma: This is a type of skin cancer that affects the nail matrix. It is characterised by brown or black discolouration on the nail.
- Peripheral artery disease (PAD): PAD reduces blood flow to the legs and feet, affecting the nail matrix and slowing down nail growth.
It is important to consult a dermatologist or healthcare provider if you are unsure about the cause of skin growth under your nails or if you notice any concerning symptoms. They can determine the appropriate treatment based on the underlying cause.
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Health conditions
A nail growing under another nail is a condition known as retronychia. It occurs when the nail plate (the hard part of the nail made of the protein keratin) grows into the nail fold. This is often caused by repetitive injury to the nail, such as wearing tight shoes or performing activities that lead to toenail injury. In some cases, it may be the result of pressure on the tip of a toenail that has grown beyond the end of the toe, lifting the end of the toenail and creating space for another nail to grow underneath.
Several health conditions can contribute to the development of retronychia:
Fungal Infections
Toenail fungus can cause nails to become thick, yellow, cracked, or cloudy. This can affect nail growth and create an environment for retronychia to develop.
Illnesses
Serious health events or illnesses, such as a heart attack, COVID-19, or pneumonia, can interrupt nail growth and cause Beau's lines (horizontal ridges in the nails). This nail abnormality can increase the likelihood of nail injuries and subsequent retronychia.
Injuries
Injuries to the nail matrix, such as pinching or crushing the finger or dropping something heavy on the toe, can directly cause retronychia. Minor damage to the nail matrix can also temporarily change the nail's appearance and growth pattern.
Medications
Chemotherapy and certain medications can affect the nail matrix, leading to Beau's lines, slow nail growth, Mees' lines (white bands), and nail colour changes. These changes usually resolve after discontinuing the medication.
Peripheral Artery Disease (PAD)
PAD reduces blood flow to the legs and feet, affecting the nail matrix and slowing nail growth. Poor blood flow can also impact the body's ability to repair short-term damage, leading to painful nails, blisters, corns, calluses, or sores.
Skin Conditions
Severe eczema and nail psoriasis can affect the nail matrix and nail growth. These conditions may result in Beau's lines, pitting (small pinhole-like dots), texture changes, colour changes, and crumbling nails, increasing the risk of nail injuries and retronychia.
It is important to consult a healthcare professional for proper diagnosis and treatment, as self-diagnosis may be challenging and delayed treatment can lead to further complications.
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Treatment and prevention
The medical term for when a nail grows under another nail is retronychia. It occurs when the nail plate (the hard part of the nail made of the protein keratin) grows into the nail fold. Repetitive injury to the nail, such as wearing tight shoes, is the most common cause of retronychia.
Treatment
If you suspect that you have retronychia, you should seek medical advice from your healthcare provider. In the acute stage, treatment options include corticosteroids that are applied to the nail and corticosteroids that are injected into the nail. Antibiotics may also be prescribed to curb any infection. In some cases, the original toenail may need to be removed so that the second toenail can grow properly.
Prevention
To prevent retronychia, avoid wearing tight shoes and engaging in activities that may cause toenail injury.
Other Nail Disorders
Another nail disorder is onycholysis, which is the separation of the nail from the nail bed. It is usually not painful, but what causes it may be irritating or painful. Onycholysis is often caused by injury to the nail or fungal infections. Treatment may involve cutting away the separated nail as it grows out, taking antifungal medications, or discontinuing the use of certain nail products. To prevent onycholysis, keep your nails trimmed short, avoid biting your nails, and be careful when cleaning underneath your nails. Avoid chemicals or products that can irritate your nails or the skin around them, such as nail polish, nail gloss, nail hardener, nail polish remover, and fake nails.
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Frequently asked questions
This condition is called Retronychia and occurs when the nail plate (the hard part of the nail made of the protein keratin) grows into the nail fold. It is caused by trauma or repetitive injury to the nail, often from wearing tight shoes.
In the acute stage, Retronychia causes pain and inflammation of the nail fold, yellow or white discoloration of the nail plate, and growth of new connective tissue on the inflamed areas. In the chronic stage, the inflammation resolves, but the nail plate becomes thickened and separates from the nail bed.
In the acute stage, treatment options include corticosteroids that are applied to the nail and corticosteroids that are injected into the nail. In more severe cases, surgery may be required to remove the nail plate and allow the nail bed to heal.
