A missing toenail often raises questions about what lies beneath and how the toe will recover. Understanding the underlying structures and natural healing processes can demystify this common occurrence, providing insight into the appearance of a toe without its nail and its path to healing.
The Appearance of a Nail-Less Toe
When a toenail is absent, the underlying area is the nail bed. This specialized, hardened layer of skin once supported the nail plate and is not raw flesh. The nail bed appears pinkish, reflecting the healthy blood supply beneath its surface. Its texture may feel smooth but can be slightly ridged or uneven where the nail previously sat.
The skin surrounding the nail bed, including the cuticle and nail folds, remains intact. If nail loss was due to trauma, the nail bed might show discoloration, such as a purplish or black hue, indicating a subungual hematoma (blood trapped beneath the surface). This discoloration fades as the injury heals. The exposed nail bed is more sensitive than a nail-covered toe because its protective keratin layer is no longer present.
Common Reasons for Nail Loss
Toenails can detach for several reasons, with trauma being a common cause. This ranges from acute incidents like stubbing a toe or dropping a heavy object, to repetitive microtrauma from ill-fitting shoes or high-impact activities such as running. Such injuries can cause blood to collect under the nail, leading to its separation.
Fungal infections, medically known as onychomycosis, are another common reason for toenail loss. These infections can cause the nail to thicken, become discolored (often white, yellow, or brown), and become brittle, eventually lifting and detaching. Psoriasis, a chronic autoimmune skin condition, can also affect nails, causing pitting, discoloration, thickening, and separation.
Less common causes of toenail loss include certain medical conditions or medications. Systemic illnesses, some prescription drugs, or chemotherapy agents can lead to nail changes and detachment. Anonychia, a rare congenital condition, means individuals are born without some or all nails due to genetic factors.
Care and Regrowth
After a toenail detaches, protecting the exposed nail bed is important to prevent infection and further injury. Clean the area gently with soap and water, and apply an antibiotic ointment. Cover the toe with a non-stick bandage for several days, changing it daily, to provide a protective barrier until the underlying skin hardens.
Toenails regrow, but it is a slow process compared to fingernails. A completely lost toenail takes 12 to 18 months to fully regrow. The new nail begins forming at the nail matrix, located at the base of the nail under the skin. Initially, the new nail may appear thin, discolored, or misshapen before gradually normalizing as it grows out.
Consult a healthcare professional if there is persistent pain, signs of infection (such as increased redness, swelling, pus, or unusual discharge). Medical attention is also recommended if the cause of nail loss is unknown, if underlying health conditions like diabetes complicate healing, or if the new nail fails to grow back properly or at all.