Ava Monroe
Toenails can take 8 to 18 months to grow completely out. If you have a new nail growing under your toenail, it could be due to a condition called onycholysis, where your nail separates from its nail bed. This can be caused by injuries or fungal infections, which can lead to pain and irritation. Another possible cause is retronychia, which occurs when the nail plate grows into the nail fold, resulting in multiple layers of nail plates. This condition is often caused by repetitive injury to the nail, such as wearing tight shoes. To address the issue of a new nail growing under your toenail, it is important to identify the underlying cause and take appropriate measures to treat it.
| Characteristics | Values |
|---|---|
| Condition | Retronychia |
| Cause | Repetitive injury to the nail, such as 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 (xanthonychia), growth of new connective tissue on inflamed areas (granulation tissue), swollen, red, and tender tissues around the nail |
| Treatment | Corticosteroids applied to or injected into the nail in the acute stage; nail removal in the chronic stage; avoiding activities that injure the nail; wearing shoes with more space for the toes |
| Prevention | Keep nails trimmed short, avoid nail biting, be careful when cleaning underneath nails, avoid chemicals or products that can irritate nails |
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What You'll Learn
Onycholysis (nail separation)
Onycholysis is a common nail disorder in which the nail separates from the nail bed. It is usually painless but can be painful if acute or inflammatory. Onycholysis can affect both sexes, all ages and races, though it is most frequently seen in adult women. It typically only affects one nail, but it can affect multiple fingernails and/or toenails.
Onycholysis can be primary (idiopathic, unknown cause) or secondary to one of many causes. Some of these causes include trauma, skin disease, nail infections, tumours, or systemic events. Photo-onycholysis is due to the ingestion of a photosensitiser, such as medication. Injuries to a nail or the area where your nails start to grow (nail matrix) can cause onycholysis. You can injure these areas by bumping or hitting your nails, wearing shoes that are too small, or even keeping your nails in water for too long. Regular manicures can also cause onycholysis, as manicurists use a lot of force to trim, buff and polish your nails. Even tapping your nails on a hard surface over a long period can cause onycholysis. Reactions to chemicals in nail products can also cause onycholysis.
Fungal infections can also cause onycholysis. These infections occur when fungi get between your nail and nail bed, usually through cracks or cuts in your finger or toe. Nails affected by fungal infections may become thick and yellow, and they may show white spots and streaks. If you have a fungal infection, it is important to keep the nail dry while it heals. Applying a mixture of tea tree oil diluted with a carrier oil, such as jojoba or coconut oil, can help get rid of the fungus.
Other causes of onycholysis include iron deficiency, hyperthyroidism, chemotherapy, and some medications that cause light sensitivity, such as tetracycline, nonsteroidal anti-inflammatory drugs (NSAIDs), psoralens and oral retinoids (vitamin A derivatives). Nail psoriasis can also cause onycholysis, as it changes the structure of your nails.
Treatment for onycholysis may involve cutting away the separated nail as it grows out, taking antifungal medications, or stopping the use of certain nail products. In the meantime, it is important to keep your nails short and trimmed and avoid activities that might harm them.
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Retronychia (nail growing into the nail fold)
Retronychia is a toenail condition where the toenail grows back into the nail fold (the skin around the nail) instead of growing outward. It is characterised by redness and swelling at the proximal nail fold and is often misdiagnosed. Retronychia is generally caused by some form of trauma affecting the proximal section of the toenail. This trauma could be caused by an acute injury, such as stubbing your toe, or it could be caused by repetitive microtraumas from wearing poorly fitting shoes that are too small or with high heels. Frequent pressure from ill-fitting shoes can injure the toenail bed, leading to retronychia.
People who engage in physical activities such as running, hiking, or dancing are also at a higher risk of developing retronychia due to the constant pressure exerted on the front edges of the toenails. Foot conditions that put extra pressure on the big toe, like misalignment of the toenails, can also contribute to the development of retronychia. Certain underlying health conditions may further increase the risk of getting retronychia.
The early symptoms of retronychia include pain, redness, swelling, and changes in nail colour. In later stages, new nails can start growing underneath the old nail, resulting in multiple layers of nails pushing against each other. This can lead to further complications such as inflammation, infection, and impaired walking.
The treatment for retronychia focuses on relieving symptoms and promoting normal nail growth. In the early stages, retronychia can sometimes be reversed by addressing the underlying cause, such as changing to better-fitting shoes, minimising activities that put pressure on the toes, or treating any underlying health conditions. In more severe or chronic cases, a procedure called nail avulsion surgery may be required to remove part or all of the affected toenail. However, even with surgical treatment, retronychia can recur, and it is recommended to continue wearing loose or open-toed shoes to prevent recurrence.
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Nail matrix injuries
The nail matrix is the area where your fingernails and toenails start to grow. It is responsible for nail growth and is located at the base of the nail. The nail matrix creates new cells that become your fingernails or toenails. A healthy nail matrix is essential for healthy nails.
Injuries to the nail matrix can cause onycholysis, also known as nail separation. This is when your nail separates from its nail bed. It often appears after an injury to your nail, but it may also be caused by fungi or yeast. Onycholysis usually isn't painful, but what causes it may be painful or irritating. If you have onycholysis due to injuries or fungal infections, you may experience pain and irritation. Injuries to the nail matrix can also cause bruising, ridges, or discoloration. Your nail may even fall off.
There are several ways to injure your nail matrix. This can be caused by mechanical injuries, such as bumping or hitting your nails, wearing shoes that are too small, or keeping your nails in water for too long. Regularly going to a nail salon to get manicures can also cause nail matrix injuries. Manicurists use a lot of force to trim, buff, and polish your nails. Even tapping your nails on a hard surface over a long period can cause nail matrix injuries.
Certain habits and improperly performed care procedures can also result in nail matrix damage. For example, individuals who have a habit of picking at the cuticle may notice a wavy nail plate. This is the result of matrix damage under the influence of too much pressure in the lunula area, where the nail is still soft and delicate. Similarly, using a drill too hard and too deep around the cuticles may damage the matrix.
Treatment for a nail matrix injury depends on the cause. For example, antifungal pills are typically used to treat nail fungus. If you have nail psoriasis, certain medications, injections, or topical treatments can help manage the condition. Relieving nail injuries may also benefit from a procedure that drains the trapped blood, called nail trephination. This procedure provides pain relief and helps the new nail grow in correctly.
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Toenail fungus
Fungal nail infections can cause yellow and thick nails, with white spots or streaks. The nail often becomes darker in colour and smells foul. Debris may collect beneath the nail plate, and white marks frequently appear on the nail plate. Toenail fungus can spread to other toenails, the skin, or even the fingernails. The infection can spread and possibly impair your ability to work or walk. Thicker nails are difficult to trim and make walking painful when wearing shoes.
To prevent and treat toenail fungus, it is important to keep your feet clean and dry, wear shoes that allow airflow, and avoid sharing personal care items. Keep your toenails short and trimmed, and avoid biting 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. Disinfect instruments used to cut nails and home pedicure tools.
If you have a fungal infection, you may need to take antifungal medications. Commonly prescribed antifungal pills include itraconazole and terbinafine. Topical treatments, such as antifungal nail polish and medicated creams, can also be helpful for mild to moderate infections. In more severe cases, a foot doctor may recommend nail removal, which can be performed surgically or non-surgically. Laser treatment is another option, but its effectiveness can vary.
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Peripheral artery disease
Onycholysis, or nail separation, occurs when the nail separates from its nail bed. It often appears after an injury to the nail, but it may be due to other causes, including fungi. Treatment may involve cutting away the separated nail as it grows out, taking antifungal medications, or discontinuing the use of certain nail products.
The symptoms of PAD include a painful ache in the legs when walking, which usually disappears after a few minutes of rest. Both legs are often affected, although the pain may be worse in one leg. Other symptoms include hair loss on the legs and feet, numbness or weakness in the legs, slow-growing and brittle toenails, and sores on the feet and legs that do not heal. Some patients may also experience a change in skin colour on their legs, such as turning paler or blue, although this may be harder to see on brown and black skin.
The only way to treat toenails with poor circulation caused by PAD is to treat the PAD itself. PAD is largely treated through lifestyle changes and medication. Regular exercise and abstaining from smoking are recommended to ease the symptoms of PAD and reduce the chances of it worsening. It is also important to address the underlying causes, including high blood pressure, high cholesterol, and diabetes.
If you suspect that you have onycholysis or peripheral artery disease, it is important to consult a healthcare professional for proper diagnosis and treatment.
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Frequently asked questions
This phenomenon is called retronychia, which occurs when the nail plate (the hard part of the nail) grows into the nail fold. This can be caused by repetitive injury to the nail, such as wearing tight shoes or participating in activities that lead to toenail injury.
Treatment options depend on the stage of retronychia. In the acute stage, corticosteroids are applied to 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 toenails.
Toenails grow slowly, and it may take 12 to 18 months for them to grow back completely.
