A “dead toenail” is a common term used to describe a toenail that has detached or is in the process of detaching from its underlying nail bed. This condition, medically known as onycholysis, means the nail has lost its connection to the living tissue that nourishes it. It often occurs due to various factors.
Identifying the Signs
Several characteristics indicate a toenail is no longer viable or attached. One of the most noticeable signs is discoloration, which can vary widely. A black or dark purple hue often signifies blood pooling underneath the nail (subungual hematoma), typically caused by trauma. White, yellow, or even green discoloration can point towards a fungal infection or other issues.
Changes in the nail’s texture and appearance are strong indicators. The nail may become brittle, thickened, or crumbly, and it might begin to lift from the nail bed. A visible gap forming between the nail plate and the skin underneath suggests separation. If the nail has lost its connection, pressing on it will not cause pain, though the surrounding toe might still be tender if an injury is present. Eventually, the nail may detach completely and fall off, often without significant pain once the area has healed.
Understanding the Causes
Toenails can detach for several reasons, with physical trauma being a common cause. Injuries like stubbing a toe, dropping a heavy object, or wearing ill-fitting shoes can lead to the nail separating from its bed. Repetitive stress from activities like running or hiking, particularly with tight footwear, can also cause chronic irritation and lead to nail detachment. This trauma can result in bleeding under the nail, which pushes the nail away from the bed.
Fungal infections (onychomycosis) are a widespread cause of toenail detachment. These infections can cause the nail to thicken, change color to yellow or white, and become brittle or crumbly, eventually leading to its separation from the nail bed. If left untreated, fungal infections can significantly damage the nail structure.
Underlying medical conditions can contribute to toenail detachment. Psoriasis, a skin condition, can affect nails and cause onycholysis. Certain systemic illnesses, such as thyroid conditions, diabetes, or reactions to some medications like chemotherapy drugs, can weaken the nail or interfere with its healthy growth, resulting in separation.
Next Steps and Professional Guidance
If a toenail appears to be detaching, self-care measures can be taken at home. Keep the area clean and dry to prevent complications. Protecting the exposed nail bed with an antibiotic ointment and a clean bandage can help prevent infection. If only part of the toenail has detached, do not force its removal; allow it to fall off naturally, trimming any sharp edges to prevent snagging.
Professional medical attention is important in specific situations. Seek prompt care for signs of infection, such as increased redness, swelling, pus, or persistent pain around the toe. A fever accompanying these symptoms warrants immediate medical evaluation. Consult a doctor or podiatrist if the cause of detachment is unclear, if the nail causes ongoing issues, or if the problem is recurrent. Individuals with underlying health conditions, especially diabetes, should seek prompt medical advice for any foot issues due to increased risk of complications.
A medical professional can diagnose the cause of toenail detachment, often through visual examination or by taking a nail clipping for laboratory analysis, particularly to check for fungal infections. Treatment options may vary depending on the underlying cause. Treatment can include draining blood from under the nail if a hematoma is present, prescribing antifungal medication for infections, or partially or completely removing the nail to promote healthy regrowth. The detached portion of the nail will not reattach; a new nail must grow in its place, which can take several months for toenails.