Damaged toenails often present as discoloration, thickening, splitting, or bruising under the nail plate. Understanding the precise cause of the damage is the first step toward successful treatment and preventing future recurrence.
Understanding the Source of Toenail Damage
Toenail damage generally falls into three categories: trauma, infection, and chronic conditions. Acute trauma, such as dropping a heavy object or stubbing a toe, can cause a subungual hematoma, which is blood pooling underneath the nail that results in black or purple discoloration. Repetitive micro-trauma, like the constant rubbing of a nail against a tight shoe during running, also causes thickening and discoloration over time.
A fungal infection is most often caused by onychomycosis, which thrives in warm, moist environments. Fungal infections typically cause the nail to become yellow, white, or brown, and it may thicken, crumble, or separate from the nail bed (onycholysis). Chronic issues, such as psoriasis or poor circulation related to conditions like diabetes, can also lead to nail deformities, making the nail brittle or prone to infection.
At-Home Solutions for Minor Damage
For damage resulting from minor trauma, like small splits or slight bruising, proper at-home care can facilitate healing and prevent secondary infection. If the nail is partially detached, the loose part should be carefully trimmed straight across to prevent snagging. The area should then be gently cleaned with soap and water, followed by the application of an antibiotic ointment and a nonstick bandage to protect the exposed nail bed.
For a bruised toenail (subungual hematoma) without severe pain, the initial treatment involves applying an ice pack wrapped in a towel for 15 to 20 minutes to reduce swelling and throbbing. Elevating the foot can also help manage the pressure and discomfort in the first 48 hours. If the discoloration is minor and pain-free, the nail will simply grow out over several months as the blood reabsorbs or moves toward the tip.
Moisturizing the nails and surrounding skin can improve flexibility and prevent cracking. Using a lotion or oil on the nail plate after bathing helps to maintain the nail’s water content. If a fungal infection is suspected to be in its early stages, over-the-counter (OTC) topical antifungal treatments containing ingredients like clotrimazole or terbinafine can be applied. However, the efficacy of these OTC products is limited, as they often struggle to penetrate the hard nail plate to reach the fungus underneath. If signs of infection, such as pus, escalating redness, pain, or odor, become apparent, professional medical attention is necessary.
Clinical Interventions for Severe or Persistent Damage
When home care is insufficient, or the damage is severe, a podiatrist or dermatologist can provide targeted medical interventions. A severe subungual hematoma causing throbbing pain may require drainage, a procedure called trephination, where the doctor creates a small hole in the nail plate to relieve the pressure from the trapped blood. For persistent or deep ingrown toenails, a podiatrist may perform a minor surgical procedure, such as a partial nail avulsion, to remove the offending portion of the nail and prevent recurrence.
Fungal infections that resist topical OTC treatments often require prescription-strength options. Oral antifungal medications, such as terbinafine or itraconazole, are the first-line treatment because they attack the fungus from the bloodstream as the nail grows. These medications require a course of 6 to 12 weeks, and the patient may need blood tests to monitor for potential side effects.
Alternatively, a doctor may prescribe a specialized medicated nail lacquer, such as ciclopirox, which is painted onto the nail daily. To enhance the penetration of topical treatments, the healthcare provider may thin the nail plate through a process called debridement. Complete clearance of a fungal infection takes time, typically spanning 12 to 18 months, because the entire damaged nail must be replaced by new, healthy growth.
Long-Term Strategies for Nail Health
Preventing future toenail damage centers on consistent hygiene and thoughtful footwear choices. Proper nail trimming involves cutting the nail straight across and avoiding rounding the corners, which helps prevent ingrown nails and potential entry points for fungus. After trimming, a file can be used to gently smooth any sharp edges, minimizing the risk of injury.
Footwear must offer sufficient space in the toe box to prevent the repetitive friction that causes nail thickening and bruising. Selecting shoes made from breathable materials and wearing moisture-wicking socks helps keep the foot dry. Changing socks immediately after intense activity and allowing shoes to dry out completely between wears are effective preventative measures. Furthermore, always wearing protective footwear, such as sandals or flip-flops, in public wet areas like communal showers and pool decks minimizes the risk of contracting a fungal infection.