Ava Monroe
Toenails grow from an area below the skin called the matrix, which is connected to the blood vessel and nerve-rich nail bed. An injury to the matrix can result in several toenail changes, including bruising, thickening, and nail loss. In some cases, a toenail injury may cause a secondary nail to grow underneath the existing one, pushing the old nail upwards. This condition is called retronychia and is often caused by repetitive injury to the nail, such as wearing tight shoes or participating in activities that lead to toenail trauma.
| Characteristics | Values |
|---|---|
| Cause | Trauma to the toe that loosens the toenail or pressure on the tip of a toenail that has grown beyond the end of the toe |
| Appearance | The second toenail starts growing underneath the existing one, so it isn't typically visible. The base of the nail may appear discolored due to the appearance of the second toenail beneath. |
| Symptoms | Mild pain or discomfort in the affected toe or a feeling of pressure on that toe. As the nail growth progresses, the existing toenail will be raised up by the nail that's growing underneath it. |
| Complications | Creates a vulnerable area for bacteria to enter, leading to an infection in the nail bed. The affected toe will become swollen, red, and painful to the touch. |
| Treatment | Antibiotics are given to curb any infection, followed by a visit to the foot and ankle clinic to have the original toenail removed so that the second one can grow properly. |
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What You'll Learn
Toenail trauma
Causes of Trauma
- Wearing tight or ill-fitting shoes that rub against the toes while walking or running can cause friction and trauma to the toenails.
- Dropping heavy objects on the toes or stubbing them can result in sudden and acute trauma to the toenails.
- Regular visits to nail salons for manicures and pedicures can also contribute to toenail trauma due to the force applied during trimming, buffing, and polishing.
- Keeping nails in water for extended periods or tapping them on hard surfaces repeatedly can also lead to toenail trauma over time.
Symptoms and Complications
- Bruising, thickening, and nail loss can occur due to injury to the nail matrix, the area where toenails begin to grow.
- Trauma can cause the toenail to become loose or separated from the nail bed, known as onycholysis, which can be painful and uncomfortable.
- Discoloration of the toenail, such as yellowing or dark discoloration, may be observed due to trauma or secondary bacterial or fungal infections that develop in the vulnerable area beneath the raised toenail.
- In severe cases of trauma, the bone beneath the nail may fracture, leading to intense pain and requiring immediate medical attention.
Treatment and Prevention
Proper treatment and preventive measures are crucial for managing toenail trauma:
- Minor injuries under the nail can benefit from nail trephination, a procedure that drains trapped blood, providing pain relief and promoting correct nail growth.
- Ingrown toenails, a common complication of toenail trauma, may require partial nail avulsion surgery, where a local anesthetic is administered, and the ingrown portion of the nail is removed.
- Antibiotics are typically prescribed to address any infections before proceeding with further treatment for secondary nail growth or other complications.
- To prevent toenail trauma, it is essential to wear properly fitted shoes that provide adequate space for the toes, trim toenails straight across to prevent ingrown nails, and avoid activities that repeatedly injure the toenails.
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Toenail infections
Fungal infections are treated with antifungal pills or cream. Over-the-counter antifungal medications are available, or you can get a prescription from your doctor. To treat an ingrown toenail, a doctor may lift the nail and place a piece of cotton or a splint underneath it, helping the nail grow away from the skin. If lifting doesn't work, the doctor may remove part or all of the affected nail.
To prevent toenail infections, cut your toenails straight across to avoid ingrown toenails. Avoid walking barefoot in common areas like gym showers or locker rooms.
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Ingrown toenails
The growth of a second toenail is often a result of toenail trauma, which can be caused by repetitive rubbing against shoes, wearing ill-fitting shoes, or a sudden injury like stubbing your toe. This trauma can lead to onycholysis, where the nail separates from its nail bed, creating space for a second nail to grow underneath. Initially, this may cause mild pain, discomfort, or a feeling of pressure, and the base of the nail may appear discoloured. As the second nail grows, it raises the existing toenail, creating an entry point for bacteria, which can lead to infection.
Toenail injuries can also lead to bruising, thickening, nail loss, and fungal infections. To prevent toenail injuries, it is important to cut toenails straight across and not too short, as this can help avoid ingrown toenails and reduce the risk of the nail catching on objects and pulling off the nail bed. Avoiding tight-fitting shoes can also relieve pressure on the toenails and prevent injuries.
In summary, the growth of a second toenail is often a result of toenail trauma, which can cause onycholysis and create space for bacterial infections. Ingrown toenails are a related issue, caused by the edge of the nail growing into the skin, leading to pain, swelling, and potential infection. Proper toenail care, including correct trimming and avoiding tight shoes, can help prevent these issues.
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Antibiotic treatments
The second toenail growing on top of the old nail plate is a condition called retronychia. It occurs when the nail plate, made of the protein keratin, grows into the nail fold. Repetitive injuries to the nail, such as wearing tight shoes, can cause this condition. Treatment for retronychia focuses on relieving nail injuries and preventing further damage.
If conservative treatments are ineffective, a minor surgical procedure called nail trephination may be performed. This procedure involves draining trapped blood under the nail to alleviate pain and promote proper nail growth. It must be conducted within 48 hours of the injury, before blood clots form.
In more severe cases of ingrown toenails, a local anesthetic may be administered to numb the toe before cutting away the edges of the toenail. Phenol is then applied to prevent the nail from growing back and becoming ingrown again. Total nail avulsion, the complete removal of the toenail, may be necessary for thick toenails pressing into the skin.
To prevent ingrown toenails, it is essential to trim toenails straight across, avoiding rounding the corners. Wearing properly fitted shoes that provide adequate space for the toes is also crucial in preventing pressure on the toenails.
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Toenail matrix injuries
Minor nail bed injuries often heal on their own, especially when no other injuries are present. However, receiving prompt professional treatment can help ensure that the nail bed heals appropriately and the nail grows back smoothly. A procedure called nail trephination can be performed to drain trapped blood under the nail, providing pain relief and aiding the growth of a new nail. This procedure must be performed within 48 hours of the injury.
In more severe cases, a doctor may remove the nail and repair the nail bed and matrix. If the finger or toe is fractured, or if there is severe damage to the nail bed matrix, part or all of the nail may be removed. With proper treatment, healthy nails will often grow back, although it may take several weeks for the new nail to appear.
It is rare for the nail matrix to be permanently damaged, but in cases of severe damage, some or all of the nail may not grow back. To prevent problems with the nail matrix, it is recommended to cut toenails straight across to avoid ingrown toenails and to avoid activities that may injure the nail, such as wearing tight shoes.
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Frequently asked questions
Toenail trauma can cause a secondary nail to grow. This can be caused by repetitive rubbing against a shoe, tight or loose shoes creating friction, or a sudden injury, like stubbing your toe.
Initially, there may be no visible signs, but you may experience some mild pain or discomfort in the affected toe, or a feeling of pressure. As the nail growth progresses, the existing toenail will be raised by the nail growing underneath it.
If you notice a second toenail growing, it is important to address the original toenail. Consult a healthcare professional, who may prescribe antibiotics to curb any infection. After that, the original toenail will be removed so that the second one can grow properly.
A second toenail growing can create a vulnerable area for bacteria to enter, leading to an infection in the nail bed. If an infection occurs, the toe will become swollen, red, and painful to the touch.
To prevent a second toenail from growing, avoid activities that cause repetitive injury to the nail. Wear shoes with more space around the toes to relieve pressure on the toenails. Keep your toenails trimmed straight across to prevent ingrown toenails.
