A split toenail, medically known as onychoschizia or onychorrhexis, occurs when the nail plate separates horizontally or longitudinally. Splits are commonly caused by trauma, such as stubbing a toe, or from repetitive pressure, often seen in athletes wearing tight footwear. The nail plate is composed of dead keratin and cannot be “healed” like living tissue, but the underlying nail bed can be repaired. The immediate goal is to stabilize the split until a healthy, new nail grows to replace the damaged section.
Immediate Care for Minor Splits
For a superficial split that does not involve deep bleeding or damage to the skin beneath the nail, immediate self-care can prevent the injury from worsening. First, gently clean the area with a mild antiseptic wash or soap and water to reduce the risk of introducing bacteria. After cleaning, carefully trim away the loose part of the nail plate using clean clippers or scissors to eliminate the snag hazard. This prevents the split from tearing further into the sensitive nail bed.
The remaining split edges must be stabilized to protect the exposed tissue. Use a small piece of medical tape or a bandage to hold the edges together and cover the area. Applying a thin layer of antibiotic ointment under the bandage can help keep the area moist and protected. Continue to monitor the toe and change the dressing daily or whenever it becomes wet to maintain a clean environment.
Professional Treatment Options
When a toenail split extends deep into the nail bed tissue, professional intervention is necessary to ensure proper healing and prevent permanent nail deformity. A podiatrist or physician will assess the damage, often by performing a partial nail avulsion, which is the selective removal of the damaged nail plate section. This procedure allows the professional to access and inspect the lacerated tissue underneath.
If the nail bed itself is cut, it must be repaired, either with fine, absorbable sutures or with specialized medical adhesives, such as 2-octylcyanoacrylate (Dermabond). Using medical-grade bonding agents for nail bed repair is faster than traditional suturing, offering similar cosmetic and functional results. In cases of significant tissue loss, a nail bed graft may be required, where tissue is transferred from another area to fill a defect larger than a few millimeters. Repairing the nail matrix, the area responsible for generating the nail plate, is a delicate process sometimes involving reconstructive techniques to ensure the new nail grows without permanent ridges or splits.
Recognizing Severe Injuries and Infection
A minor split can quickly escalate if certain symptoms appear, indicating a need for urgent professional medical attention. Uncontrolled bleeding, particularly if it continues after applying direct pressure for several minutes, is a sign that the laceration is deep and requires sutures.
Any signs of infection should prompt an immediate visit to a healthcare provider. These signs include:
- Increasing redness, warmth, or throbbing pain.
- Swelling that spreads beyond the immediate injury site.
- The presence of pus or foul-smelling discharge.
A split that extends into the cuticle area (the nail matrix) is a serious injury that must be evaluated by a professional to minimize the risk of permanent nail growth issues. If the injury causes pain that prevents you from bearing weight or walking normally, an X-ray may be needed to rule out an underlying toe fracture.
The Process of Nail Regrowth
Regardless of whether the split was managed at home or repaired medically, the damaged nail section will not fuse back together; the resolution is the growth of a new, healthy nail plate. Toenails grow much slower than fingernails, and the full replacement process takes a considerable amount of time. On average, a toenail requires approximately 12 to 18 months to fully regrow from the nail matrix to the tip of the toe.
During this lengthy regrowth period, the new nail will slowly push the old, damaged nail forward until it is completely replaced. Keep the new nail growth protected from friction and trauma. Wearing well-fitting, comfortable footwear and moisturizing the nail and surrounding skin regularly supports the healthy development of the new nail plate.