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If your toenail suddenly becomes loose and falls off, it can be alarming. There are some obvious reasons why your toenail may fall off, like an injury. However, sometimes the toenails can loosen and fall off spontaneously.
Let’s discuss all the different reasons your toenail is falling off and what you can do about it.
Let’s dive in…
Subungual Hematoma
If you injure your toenail, you may develop a subungual hematoma, which can cause loosening of the toenail. A subungual hematoma is when there is a build-up of blood underneath your toenail, usually due to an injury.
Say you drop something heavy on your toenail. You may develop bruising with the accumulation of blood underneath the nail. If there is enough blood underneath the nail, the pressure of the blood can push the nail upwards and cause it to become loose and fall off.
Occasionally, you may not even notice that you developed a subungual hematoma.
For instance, if you tend to wear tight shoes and constantly hit the end of your toes against your shoes, you may develop a subungual hematoma and not even be aware of it.
This is especially true in patients who suffer from neuropathy and can’t feel pain in their toes.
Runners can develop subungual hematomas easily due to repetitive forces of their toes hitting against the edge of their shoes.
If you notice that your toenail plate has greater than 50% of blood underneath it, there’s a big chance that your toenail may fall off.
If you want to read more about subungual hematomas, you can read about it in a supplemental post here about black toenails.
Related article: Is Your Toe Broken? Here’s Everything You Need To Know
Fungal Infections
If you develop a fungal infection in your toenail, you will notice certain changes in your toenail. Your toenail may become thickened and discolored (yellow or white). When the fungus is present in the nail plate, it is also present in the nail bed.
The fungus can cause debris to accumulate underneath the nail plate. Over time, this can cause your toenail to loosen and fall off. Usually, this does not cause any pain, and can even go unnoticed.
Fungal infections are very contagious. They are present in high amounts in communal environments like swimming pool floors and locker rooms.
Read more on How To Prevent Fungal Infections From Spreading And Recurring.
Related post: Is Vicks VapoRub Effective For Toenail Fungus?
Psoriasis
Psoriasis is an autoimmune condition that can cause skin cells to multiply at a rapid rate. This can cause specific changes to occur in your toenails such as:
- Ridging of the toenails
- Pitting of the toenails
- Loosening of the toenails
- Hardening of the toenails
Psoriasis can also cause arthritis in the small joints in your toes. Interestingly, a study done by T.Love in the Journal of Rheumatology revealed that onycholysis of the toenail has a strong association with psoriatic arthritis (1).
This means that if you have psoriatic arthritis in your toes, you may notice that your toenails loosen more compared to people who don’t have psoriatic arthritis.
Medications
Certain medications can cause your toenails to loosen. Certain chemotherapy drugs like Paclitaxel can cause the toenail to loosen from the underlying nail bed. Other medications that can cause your toenail to fall off include tetracyclines and certain NSAIDs (2).
Thyroid Conditions
Thyroid dysfunction can affect the shape and appearance of your toenails. Loosening of the toenails may be seen in hyperthyroidism mostly (3) but can be seen in hypothyroidism as well.
Idiopathic Causes
Your toenail may fall off due to idiopathic causes.
If you grow out your toenails too long they can be susceptible to injury. If your toenails are exposed to wet environments regularly, your nail may be at risk of loosening and falling off. Overzealous manicures can also cause the nails to loosen (4).
What You Should Do When Your Toenail Is Falling Off
- Don’t Panic
If your toenail is starting to loosen, gently cleanse the toe using soap and water. Take some nail nippers and carefully trim away any sharp edges at the end of the nail so it doesn’t catch on anything.
Make sure to cut the nail straight across and not leave any jagged edges. Apply antibiotic ointment to the toe. You can secure the remaining toenail plate down to the nail bed with a band-aid. If you can’t reach down and trim your toenails, you can contact a Podiatrist to help you.
If the majority of the toenail is very loose, do not pull it out yourself. It’s best to see your foot doctor so he/she can properly numb up your toe and carefully remove the nail. This will help prevent infection.
- If Your Toenail Becomes Black and Painful, Seek Help.
If you have a painful subungual hematoma, you will need to see your doctor and have the hematoma evacuated. The buildup of blood underneath the toenail can be extremely uncomfortable.
This will need to be evacuated usually by removal of the toenail. In the meantime, if you can, you can take an anti-inflammatory such as Ibuprofen for pain control.
After nail removal, you can usually resume your normal activities. Your doctor will also want to take x-rays of your toe to make sure that you did not break a bone. If you break a bone in your toe, bone healing can take 4 to 6 weeks minimum. Your doctor may suggest you walk in a post-op shoe until the broken bone heals.
- Watch for Any Signs of Infection
If your toenail is loose, this can create a portal for bacteria to enter the skin. If you notice that your toe is becoming red, swollen, or hot to the touch, you may have an infection. It’s best to contact your doctor. Your doctor may suggest an antibiotic.
What You Can Expect After Your Toenail Falls Off
Toenails often grow back very slowly compared to fingernails.
On average, a toenail can take anywhere from 6 months to 1 year to grow out.
However, some people may notice that the nail never fully grows out. This can be due to repetitive damage to the nail matrix, which is where the nail-creating cells are.
Say for instance your toe has accidentally been stepped on multiple times. You may notice that your toenail grows slowly and even in a deformed manner. This is due to damage to the nail matrix.
It’s also important to remember that once your toenail falls off, the nail does generally grow back slightly thicker. It’s important to check for things like fungus. You will want to make sure that your nail is normal looking in thickness and color.
If you notice yellow, white, or green discoloration in your nail suggestive of fungal or bacterial infection, you’ll want to contact your doctor for appropriate medications to treat this.
What Are Treatments to Help Your Nail Grow Back Faster?
Although you can’t necessarily force your toenails to grow faster, there are some things that you can do that can help. You can take a Biotin supplement which can help support nail growth. Avoid using harsh soaps on your toes, and make sure to keep your toes clean and dry.
How You Can Prevent Toenails From Falling Off
You can help prevent your toenails from falling off by properly taking care of your feet. Make sure that when you’re in public places you wear shoes so that you don’t develop fungal or bacterial infections.
You should also make sure to avoid wearing shoes that are too tight.
Have your feet measured at a shoe store at the end of the day and make sure to get a shoe that is half an inch larger than your longest toe to prevent the tips of your toes from hitting the edge of your shoes.
Make sure to properly trim your nails straight across. You should allow the nail plate to extend 2 mm past the tip of the nail bed and cut the nail straight across.
If there is one toenail that is bothersome and constantly falls off, you may want to consider having the nail permanently removed. You can see your foot doctor for this.
Your doctor will numb the toe using a local anesthetic. Once the toe is numb, he/she will remove the toenail. Your doctor will then use a strong acid called Phenol to burn the nail matrix so that the toenail doesn’t grow back.
What You Can Do While You’re Waiting for Your Toenail to Grow Back
Wait at least 1 month after your toenail falls off before starting cosmetic work on your toe (5). Afterward, as long as there is no infection, you can safely get a pedicure.
As long as the toenail bed is clean, it is okay to paint your toenail bed while waiting for your toenail plate to grow back. If you notice that you are developing pain, redness, or pus in the toe, stop painting your toenails and call your doctor.
There are also unique toenail stickers that you can apply to your toenail bed safely. Avoid harsh glues. Acrylic nails can be difficult to secure to the toes.
Whatever you do, make sure you do not glue your lost toenail back onto your toenail bed. This can be unsanitary and can create a portal of entry for bacteria.
What to Do if Your Toenails Are Growing Back Thick
If your toenail grows back thick and you want to know how you can thin it down, you can use a nail softening agent such as Urea 47% Nail gel twice a day. Urea breaks down the hard keratin in the skin and the nails. It will take a long time to work, but can be beneficial.
Another alternative would be to apply Vitamin E oil to the toenails daily. This can help strengthen and keep your nail hydrated.
However, your toenail may have toenail fungus in it if it is growing back thick. In this case, nail softening agents won’t work. You will need to treat the fungal nail with an antifungal directly by either using topical or oral antifungals. It’s best to see your doctor for this as prescription antifungals work better than over-the-counter products.
There are home remedies for fungal toenails such as the application of Vicks Vapor Rub and soaking the toenails in Vinegar/Listerine, however, these are not as effective as prescription remedies.
In Conclusion
It can be so frustrating when your toenail constantly falls off. If you understand the reasons this is occurring, you can treat the problem accordingly. Our toenails serve to protect us from trauma. Although you can live without toenails, it’s best to keep them unless they cause chronic pain and infection.
Has your toenail ever fallen off? What caused it to fall off? I’d love to hear your thoughts. Leave a comment below!
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References
- Love, T. J., Gudjonsson, J. E., Valdimarsson, H., & Gudbjornsson, B. (2012). Psoriatic arthritis and onycholysis—results from the cross-sectional Reykjavik psoriatic arthritis study. The Journal of rheumatology, 39(7), 1441-1444.https://www.jrheum.org/content/39/7/1441.short
- Al-Kathiri, L., & Al-Asmaili, A. (2016). Diclofenac-Induced Photo-Onycholysis. Oman medical journal, 31(1), 65–68. https://doi.org/10.5001/omj.2016.12.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4720947/
- Malan, M., Dai, Z., Jianbo, W., & Quan, S. J. (2019). Onycholysis is an early indicator of thyroid disease. Pan African Medical Journal, 32(1).https://www.ajol.info/index.php/pamj/article/view/208357
- Jadhav, V., Mahajan, P., & Mhaske, C. (2009). Nail pitting and onycholysis. Indian Journal of Dermatology, Venereology, and Leprology, 75(6), 631. https://ijdvl.com/?view-pdf=1&embedded=true&article=58449a9facaf91cd6e13b98933f845d1uB3hK%2F4%3D
- Daniel, C. R., Tosti, A., Iorizzo, M., & Piraccini, B. M. (2005). The disappearing nail bed: a possible outcome of onycholysis. CUTIS-NEW YORK-, 76(5), 325.https://cdn.mdedge.com/files/s3fs-public/Document/September-2017/076050325.pdf
- LORIA, K. (2013). En pointe (Doctoral dissertation, These podiatrists reveal secrets to treat professional ballet dancers. Podiatry Management).https://podiatrym.com/pdf/2013/11/Loria1013.pdf
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