Sophia Delgado
Fingernails and toenails are composed of protein and fat and are not live tissue. Nails grow a bit more than one-tenth of an inch per month and require 3-6 months to completely regrow. Toenails typically take longer to grow back than fingernails. Nails are produced by the nail matrix, which is the factory where your body makes new nails. Certain injuries and illnesses can damage your nail matrix and affect how your nails look or grow. If the nail matrix is not damaged, the nail is typically capable of regrowth. However, if the matrix is injured, a ridge or split can develop, and the new nail may grow back deformed.
| Characteristics | Values |
|---|---|
| Nail regrowth | Nails grow back slowly, taking about 2-6 months for fingernails and 4-18 months for toenails |
| Nail matrix damage | If the nail matrix is damaged, the new nail may contain defects or deformities; if the matrix heals normally, the deformity will disappear as the nail regrows |
| Nail bed damage | Damage to the nail bed can cause whitish changes in the nail; a minor surgical procedure may improve the nail's appearance |
| Subungual hematoma | Blood accumulates between the nail and the nail bed, causing pain; a doctor can relieve this by drilling a small hole in the nail to drain the blood |
| Nail separation | Nails will not reattach after separating from the nail bed; covering the nail bed with petroleum jelly and an adhesive bandage can help protect it while the new nail grows |
| Nail injuries | Injuries can cause ridges, bumps, or splits in the nail; proper treatment can help the nail grow back smoothly |
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What You'll Learn
Nail injuries and treatment
A nail injury can occur when any part of the nail gets injured, including the nail, nail bed, cuticle, and the skin around the sides of the nail. This can happen when the nail is cut, torn, smashed, or bruised, or the nail is torn away from the skin. Smashing a finger in a door, hitting it with a hammer or another heavy object, or cutting it with a knife or another sharp object can cause a nail injury.
If the nail lifts completely off the nail bed, it may be most comfortable initially to replace the nail and hold it in place with a bandage. Nails will not reattach themselves to the nail bed after they have separated from it, but in most cases, a new nail will slowly regrow. If blood under the nail occupies more than half of the nail area, a physician should evaluate the finger because it could signify an underlying bone fracture or tissue tear.
If there is bleeding between the nail and the nail bed, a physician can perform a procedure called nail trephination, which involves drilling a tiny hole in the nail plate to relieve the pressure of the accumulated blood. This procedure should be performed within 48 hours of the injury, before the blood clots.
For a mild nail injury, it is recommended to treat the wound by gently cleaning it with soap and water. If the wound is bleeding, do not put a dry bandage or gauze on top as it will stick. Instead, apply petroleum jelly to keep the wound moist and then cover it with gauze or a bandage. Repeat these steps every day while the wound heals.
To prevent another nail injury, keep your nails short so they do not bend or catch on objects. Make sure your shoes fit well and have a wide toe box to prevent rubbing. Wear the proper gear to protect your nails while playing sports.
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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 nail's cells are made and is responsible for your nail's growth. The nail matrix has two parts: the germinal matrix and the sterile matrix. About 90% of your nail growth comes from your germinal matrix, which is the area of the nail below the lunula (closest to the knuckle). The remaining 10% of cells that make up your nails come from the sterile matrix, which is the area of the nail above the lunula.
Injuries and certain health conditions can damage your nail matrix and affect how your nails look or grow. Trauma to the nail can cause the production of new nail cells to stop for as long as three weeks. Nail growth will usually resume at a faster rate and stabilise after about 100 days. You may notice the nail appears thicker than usual. If you have a deep cut or trauma to the germinal matrix at the base of the nail, it’s possible the nail may never grow back.
Minor damage to your nail matrix can temporarily change your nail’s appearance. You might notice dents (large or small), horizontal ridges or lines, pain or soreness, splits or cracks, spots or streaks of colour, texture changes, such as becoming thicker or crumbly, bruising, or a rough surface. These typically resolve over time as the damaged nail grows, allowing new, healthy cells to replace the affected area.
In cases of severe nail matrix damage, some or all of your nail may not grow back. Conditions like chronic thickening, uneven or irregular growth, or, in rare cases, complete and permanent nail loss may occur. It is important to recognise changes in nail growth after injury, as this can guide your approach to treatment. Consulting with skilled practitioners can help you determine the best course of action to restore nail health.
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Nail bed injuries
Fingernails and toenails are composed of protein and fat and are not live tissue. Nails grow a bit more than one-tenth of an inch per month and require 3-6 months to completely regrow. Toenails grow more slowly than fingernails. Nails are produced by the nail matrix cells that reside in the moon-shaped whitish area (lunula) at the base of the nail.
If there is damage to the nail matrix, the growing nail plate will contain a defect. Minor damage will produce minor defects in the nail. More significant defects can result in a permanently deformed nail. Damage and scarring of the nail bed can produce whitish changes in the nail. This is most likely due to a lifting of the nail plate away from the nail bed (onycholysis). If the nail matrix is not damaged, the nail is typically capable of regrowth. The nail protects the nail bed, the skin at the upper tip of the finger or toe.
If your nail lifts completely off the nail bed, it may be most comfortable initially to replace the nail and hold it in place with a bandage. Nails will not reattach themselves to the nail bed after they have separated from it, but in most cases, a new nail will slowly regrow. If blood under the nail occupies more than half of the nail area, a physician should evaluate the finger because it could signify an underlying bone fracture or tissue tear. Your doctor should also evaluate bleeding under the nail that is not caused by trauma. If the trauma to the nail injures the nail matrix, a ridge or split can develop. If the matrix heals normally, this deformity will eventually disappear as the nail regrows.
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Toenail trauma
To prevent toenail trauma, it is recommended to wear properly sized shoes that fit well and provide enough room in the toe box. Silicone or gel toe caps can also be purchased to help prevent blisters, rubbing, and irritation. Keeping toenails trimmed straight across can help prevent ingrown toenails, and avoiding habits such as nail biting and cuticle biting can also reduce the risk of trauma to the nails.
If the toenail has been traumatically injured, it may take up to 12 months for it to regrow completely. During this time, the new nail may appear misshapen with grooves or ridges, and these changes may be temporary or permanent depending on the severity of the injury. In most cases, with proper medical care, healthy nails will grow back, but severe damage to the nail matrix can result in permanent nail deformities or prevent the nail from growing back altogether.
If the nail matrix is injured, a ridge or split can develop in the new nail. However, if the matrix heals normally, this deformity will eventually disappear as the nail regrows. Minor damage to the nail matrix will produce minor defects in the nail, while more significant damage can result in permanent deformities. To promote nail health and support the healing process, maintaining a well-rounded diet and good general health is recommended.
In summary, toenail trauma is a common injury that can often be managed at home, but severe cases may require medical attention. Preventative measures include wearing properly sized shoes and toe caps, trimming toenails straight across, and avoiding nail-biting habits. Toenail regrowth can take up to a year, and the new nail may initially appear misshapen but will usually improve over time. With proper care, healthy nails will typically grow back, but severe damage to the nail matrix can result in permanent deformities or nail loss.
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Nail deformities
Types of Nail Deformities
- Discoloration: Changes in nail colour, such as dark streaks, white streaks, or yellowing, can be caused by various conditions, including fungal infections, bacterial infections, and viral warts (periungual warts). Yellow nail syndrome, characterised by thickened, slow-growing, and detached nails, is associated with lung disorders and lymphedema.
- Separation: Nails can separate from the nail bed, a condition called onycholysis, which can be due to infection, trauma, or products used on the nails.
- Pitting: Small depressions or pits in the nail can be a sign of nail psoriasis.
- Ridges: Vertical ridges are common with aging, while horizontal ridges or splits can be caused by trauma to the nail matrix.
- Brittle nails: Nails can become brittle due to long-term exposure to moisture or nail polish, nutritional deficiencies (such as low zinc and iron levels), or thyroid problems.
- Thickening: Nails may thicken due to fungal infections, bacterial infections, or conditions such as pachyonychia congenita or yellow nail syndrome.
- Spoon-shaped nails: Concave or spoon-shaped nails (koilonychia) can be a sign of iron deficiency or Plummer-Vinson syndrome.
- Oil spots: Irregular pits and areas of yellow-brown discolouration (oil spots) can be a sign of psoriasis.
- Dorsal pterygium: This condition is characterised by the fusion of the nail to the underlying skin, resulting in atrophy of the nails.
Treatment and Prevention
Most nail injuries and deformities can be treated with proper medical care. Minor defects in the nail due to minor damage to the nail matrix will usually heal over time. In some cases, a minor surgical procedure may be necessary to improve the nail's appearance. Keeping nails trimmed, wearing properly sized shoes, and avoiding nail-biting can help prevent nail trauma and deformities. Maintaining a well-rounded diet and good general health can also contribute to strong and healthy nails.
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Frequently asked questions
Yes, in most cases, your nail will slowly regrow. It may take several weeks for your new nail to appear. Toenails take longer to grow back than fingernails.
If your nail falls off, you can keep the nail bed dry, clean, and covered with petroleum jelly and an adhesive bandage until the nail has grown back. You should also watch for signs of infection, such as increasing heat, redness, pain, tenderness, swelling, or pus.
If the nail matrix is damaged, the growing nail plate will contain a defect. Minor damage will produce minor defects in the nail, while more significant damage can result in a permanently deformed nail. However, with proper treatment, you can often see healthy nails grow back.
