Caleb Foster
Toenails are made from keratin, the same protein that makes up your skin and hair, and they play an important role in protecting the soft tissue beneath them. Losing a toenail due to trauma, infection, or other reasons can be painful and may require medical attention. In some cases, a new nail will grow in and replace the old nail, pushing it off as it grows, which can take up to 18 months. During the healing process, it is important to keep the wound dry and covered to prevent infection and promote nail growth.
| Characteristics | Values |
|---|---|
| Toenail regrowth time | 6 months to 18 months |
| Toenail fungus regrowth time | 12 to 18 months |
| Fingernail regrowth time | 4 to 6 months |
| Nail matrix healing time | Several weeks to several months |
| Nail bed healing time | 7 to 10 days |
| Bruise under the nail healing time | A few weeks |
| Treatment | Keep the wound dry and covered, apply antibiotic ointment, take OTC anti-inflammatory drugs, take biotin supplements |
| Prevention | Cut nails straight across, wear proper footwear, avoid shoes that are too tight, seek treatment for nail changes or injuries |
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What You'll Learn
Toenail fungus
In more serious cases, it is recommended to seek medical attention. A provider may prescribe antibiotics to prevent infection and, in some cases, perform a procedure called nail trephination to drain trapped blood, providing pain relief and aiding in the proper growth of the new nail. Additionally, subungual melanoma, a type of skin cancer, may require surgical removal, chemotherapy, or radiation treatment.
To prevent toenail fungus and maintain healthy toenails, it is important to practice proper nail care and footwear habits. This includes cutting toenails straight across to prevent ingrown toenails, wearing properly fitted shoes, and avoiding shoes that are too tight. Protecting the nails from frequent repetitive pressure, such as by ensuring shoes have enough depth in the toe box, can also help prevent toenail issues.
While toenails may take a significant amount of time to grow back, proper care and treatment can promote healing and reduce the risk of complications. It is always advisable to consult with a healthcare professional for personalised advice and treatment options.
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Nail injuries
A toenail injury can have a huge impact on your life. A toenail can be injured by a blow to the nail or by trapping the toe in a door or drawer. This kind of trauma commonly results in blood under the nail, known as a subungual hematoma. Nails can also be accidentally torn or split, or a splinter can get under the nail.
Toenail injuries can also occur due to the friction of ill-fitting shoes. This can lead to deformities in the nails, resembling a fungal infection. Nails can thicken or become discoloured and lift away from the nail bed. Toenail injuries can also be caused by nail biting and cuticle biting. Nail biting is a leading cause of acute paronychia, an infection where bacteria get under the tissue at the side of the nail, causing swelling and irritation.
If the injury is minor, you may be able to treat it at home. You should stop any bleeding, ensure the nail is not cut or torn and is still attached, and check that the nail bruise covers less than a quarter of the nail. If the nail is torn or jagged, trim it to avoid further injury. If the nail has lifted off the nail bed, you can replace and bandage it, but it will not reattach. Nails will slowly regrow, but this can take 12 to 18 months, and the new nail may look different.
If the injury is more severe, you should seek medical attention. If blood under the toenail covers more than half of the nail area, you should seek urgent medical attention to drain the blood and relieve pressure under the nail. Do not attempt this at home. If the injury includes the base of the nail, some cosmetic changes may be permanent. If you have any condition that affects healing or circulation, it is important to seek medical advice.
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Nail matrix damage
The nail matrix is the "factory" where your body makes new fingernails and toenails. It is where your fingernails and toenails start to grow and create new cells that become your nails. The nail matrix has two parts: the germinal matrix and the sterile matrix. The germinal matrix is responsible for about 90% of nail growth, giving a natural curvature to the nail, while the sterile matrix is responsible for the remaining 10% of cells that make up your nails and is more important in keeping your nail attached to the underlying skin.
Injuries and certain health conditions can damage your nail matrix and interfere with nail growth. Trauma to the nail can cause the production of new nail cells to stop for as long as three weeks, and severe trauma, such as crushing injuries or deep cuts, may result in long-term or permanent effects if the nail matrix is significantly damaged. Minor damage to your nail matrix can temporarily change your nail's appearance, and you might notice a change in how your nail feels to the touch. A severe injury could cause your nail to fall off.
If you have a bruise under your nail, a procedure called nail trephination can be performed to drain the trapped blood, providing pain relief and helping your new nail grow in correctly. This procedure must be performed within 48 hours of the injury. In cases of severe nail matrix damage, some or all of your nail may not grow back, and you should ask your provider if you should protect your finger or toe during physical activity. However, it is rare for your nail matrix to be permanently damaged, and with the right treatment, you can often see healthy nails grow again.
Certain illnesses can also damage your nail matrix and affect how your nails look or grow. Subungual melanoma (or nail matrix melanoma) is a condition where cancerous cells grow in the nail matrix, causing changes in pigments in the nail known as melanin. Pterygium unguis is a condition that causes scarring that extends to the nail matrix, resulting in a ridged appearance on the nail plate. Lichen planus, burns, and lupus erythematosus cause pterygium. A nevomelanocytic nevus is a mole or collection of melanocytes under the nail matrix that can be present from birth or acquired following nail trauma or aging.
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Toenail growth timeline
Toenails grow back, but the timeline depends on several factors, including the reason for the damage, the type of treatment, and individual factors like age, hormones, and habits.
On average, it takes a toenail 12 to 18 months to grow back completely. However, this timeline can vary depending on the specific circumstances. For example, if you have severe nail fungus, recurrent ingrown toenails, or a large section of diseased or damaged nail, surgical removal may be necessary. After medical removal, it can take up to 18 months for the nail to fully regrow.
The growth rate of toenails is relatively slow compared to fingernails. Toenails grow at about one-third to half the rate of fingernails, with an average growth rate of 1.62 millimeters per month. This growth rate can be influenced by various factors, such as age, hormones, and overall health. For example, nails tend to grow slower in older adults and in colder climates.
Certain medical conditions can also impact nail growth. People who are immunocompromised, paralyzed, malnourished, have an infection, or are undergoing specific drug therapies may experience much slower nail growth. Additionally, nail growth rates can be affected by habits such as nail-biting or frequent nail clipping, which can stimulate circulation in the nail bed and promote faster growth.
In the case of nail matrix damage, which is the area where your nails form, it may take several weeks for a new nail to appear. Minor damage to the nail matrix can cause temporary changes in the nail's appearance, while severe damage could result in the nail falling off. Proper care of the nail matrix is essential for healing and nail regrowth.
To promote healthy nail growth, it is recommended to eat a nutritious and well-balanced diet, practice good nail hygiene, and take biotin supplements, which contribute to faster nail growth by promoting cell growth and aiding in metabolizing protein-building amino acids.
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Preventing toenail issues
Toenail issues can be caused by medical conditions, injuries, or infections. While some toenail issues can be treated at home, others may require medical attention. Here are some ways to prevent toenail issues:
Keep Your Nails Dry and Clean
Fungi thrive in dark and damp environments. Keeping your nails clean and dry can help prevent fungal infections. Change out of wet shoes and socks as soon as possible.
Trim Your Nails Properly
Toenails should be trimmed straight across to prevent ingrown toenails. Avoid tearing or ripping your nails. Also, ensure you clean your nail trimmer before use.
Wear Proper Footwear
Wear shoes that fit correctly. They should not be too loose or too tight. If you play sports, wear shoes that are suitable for your sport and ensure they are the right size. Replace your shoes when they become worn or start hurting your feet. Avoid wearing shoes that are too tight.
Take Care of Your Nails
If you notice any abnormal changes to your toenails, such as colour changes, pitting, ridges, lines, or texture changes, seek treatment. Keep your nail bed dry and covered if you experience any trauma to your toenails. Clean and dry your nail bed daily and cover it with a bandage, changing it once a day. Apply antibiotic ointment to prevent infection.
Prevent Toenail Fungus
Fungal nail infections can be difficult to cure. Fungi thrive in dark and damp environments, so keep your feet dry. Wear the proper footwear in public places like saunas or locker rooms, where others with infections may have walked barefoot.
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Frequently asked questions
Toenails can take anywhere from 6 months to 18 months to grow back. The timeline depends on the reason for the nail loss, be it trauma, fungus, or another health condition.
Keep the wound dry and covered. Clean and dry your nail bed daily and cover it with a bandage, changing it once a day. Apply antibiotic ointment to the damaged nail to prevent infection. Take biotin supplements to promote cell growth.
If you have a bruise under your nail, you may benefit from a procedure called nail trephination, which involves creating a small hole in the nail to drain the trapped blood. This procedure must be performed within 48 hours of the injury, before the blood clots.
