Monday, May 20, 2024
FOOT HEALTH Skin and Nail Problems

Toenail Is Falling Off: Understanding the Causes & Treatments of Toenail Loss

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If your toenail is falling off, it can certainly be a cause for concern. While the common culprits such as physical injuries are often to blame, your toenail may surprisingly shed itself spontaneously at times. 

In this article, you will learn what causes toenails to fall off, how to treat it, and how to prevent it from happening. 

What You Should Do When Your Toenail Is Falling Off 

When you notice your toenail beginning to loosen, it’s important to respond swiftly and carefully. Start by gently cleaning the affected toe using soap and water.

Then, using nail nippers, trim any sharp edges at the end of the nail, ensuring it doesn’t snag on anything.

It’s crucial to cut the nail straight across, avoiding any jagged edges. After this, apply an antibiotic ointment to the toe and use a band-aid to secure the remaining toenail plate to the nail bed.

If you find it difficult to reach your toenails for this process, don’t hesitate to seek help from a Podiatrist.

In situations where the majority of the toenail is loose, resist the temptation to pull it out yourself. Instead, consult a foot doctor who can properly numb your toe and remove the nail carefully, thus preventing potential infection.

If a heavy object falls on your toenail, resulting in a painful subungual hematoma, it’s crucial to see your doctor for hematoma evacuation.

The accumulated blood underneath the toenail can cause significant discomfort and usually requires toenail removal. To manage the pain, consider taking an anti-inflammatory medication like Ibuprofen, if you’re able.

Post toenail removal, resuming your normal activities is typically possible.

However, your doctor might want to take x-rays of your toe to rule out any bone fractures. If a break is detected, healing may take between 4 to 6 weeks.

During this period, your doctor may recommend staying weight bearing on your heel in a post-op shoe to facilitate the healing process.

Remember, a loose toenail can act as a gateway for bacteria, potentially leading to an infection.

Keep an eye out for symptoms such as redness, swelling, or a hot sensation in your toe. If you observe any of these signs, contact your doctor promptly. They may prescribe an antibiotic to manage the infection.

What Causes A Toenail to Fall off?

subungual hematoma

1) An Injury to the nail and nail bed (Subungual hematoma) 

In the event of a toenail injury, you might find yourself dealing with a condition known as a subungual hematoma, which often results in the loosening and potential loss of the toenail. This term refers to the accumulation of blood beneath the toenail, typically as a consequence of an injury.

Imagine accidentally dropping a heavy object onto your toe. This could lead to bruising and a buildup of blood beneath the nail. If the volume of this blood is significant, the pressure it creates can cause the nail to lift, loosen, and ultimately detach.

Interestingly, there are cases where a subungual hematoma may develop unbeknownst to you. For instance, frequently wearing tight shoes and causing your toes to repeatedly hit against them may result in such a condition, even without your awareness.

This is particularly relevant for individuals living with neuropathy, who lack sensation in their toes and may not register the associated pain. Runners, too, are susceptible to developing subungual hematomas due to the repetitive impact of their toes against the front of their shoes.

If you observe that more than half of your toenail plate is underlain by blood, it’s highly likely that your toenail may be on the verge of falling 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

Subungual hematoma home remedies

When dealing with a subungual hematoma at home, there are several remedies that can help to alleviate discomfort and facilitate healing.

It’s important to keep the foot elevated and apply a cold pack to reduce swelling. Over-the-counter pain relievers such as Ibuprofen can also be used to manage pain.

In addition, soaking the affected foot in cool salt water may aid in reducing inflammation.

fungal infection

2) Fungal Infections can cause your nail to fall off

Fungal infections can significantly contribute to toenail loss. Upon contracting a fungal infection, you might notice some transformations in your toenail.

It may thicken and assume a yellow or white discoloration. The presence of fungus not only affects the nail plate but also extends to the nail bed.

With time, the fungus can cause the build-up of debris beneath the nail plate, ultimately leading to the loosening and potential detachment of the toenail. This process is typically painless and can even occur without you noticing.

Bear in mind that fungal infections are highly contagious. They thrive in communal environments such as the floors of swimming pools and locker rooms, making these places hotspots for transmission.

Read more on How To Prevent Fungal Infections From Spreading And Recurring.

Related post: Is Vicks VapoRub Effective For Toenail Fungus?

psoriasis

3) 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

4) 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

5) 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. 

5) 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 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 nail

 falls off, the nail does generally grow back slightly thicker. It’s important to check for things like fungus and an ingrown nail. 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. 

gym locker room

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. These infections cause your toenails fall off.

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 nail 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 nail. Your doctor will then use a strong acid called Phenol to burn the nail matrix so that the nail 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 nail 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 nail bed is clean, it is okay to paint your nail bed while waiting for your nail 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 nail stickers that you can apply to your nail 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.

toe infection

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. 

When should you see a doctor about the health of your toenail?

There are many reasons to see a foot doctor. Knowing when to seek medical advice about the health of your toenail is critical. You should contact a healthcare professional if you notice persistent changes such as discoloration, thickening, or deformity of your toenail. Pain, swelling, redness or a foul odor around the toenail also warrant medical attention.

In Conclusion

In conclusion, the health of your toenails, particularly the big toenail, is not something to be overlooked. Whether it’s an ingrown toenail or a toenail falling off, these conditions can potentially affect your overall well-being and mobility. It’s vital to seek professional advice and opt for a clinic appointment for a thorough evaluation when you notice any consistent changes.

It’s also crucial to remember that certain footwear can contribute to these issues, so choose wisely. Treatment may vary from simple home care practices to more invasive options like surgery, depending on the severity and cause of the problem. 

Whether you are a person who’s already facing these conditions or someone seeking preventive measures, understanding the causes, treatments, and preventions is a significant step towards maintaining excellent foot health. 

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References

  1. 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
  2. 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/
  3. 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
  4. 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
  5. 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
  6. 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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Vaishnavi Bawa
Dr. Vaishnavi Bawa is a Podiatrist who specializes in treating foot and ankle pathology. LifesLittleSteps mission is to educate the public about foot health in an easy-to-understand manner using evidence-based medicine.
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