Toenails that grow upward or thicken significantly are often a source of discomfort and can interfere with routine activities. This phenomenon often relates to conditions such as Onychogryphosis (ram’s horn nail) or pincer nails, where the sides curl inward, putting pressure on the nail bed. This change in nail growth requires careful and consistent management to prevent pain, infection, and mobility issues. Understanding the underlying reasons for this abnormal growth is the first step toward effective treatment and maintaining foot health.
Underlying Reasons for Upward Nail Growth
The primary factor contributing to abnormal thickening and upward growth is chronic physical stress on the nail matrix, the area responsible for nail production. Repetitive micro-trauma, often caused by ill-fitting footwear that crowds the toes, can permanently damage the matrix. This damage leads to the uneven production of keratin, causing the nail plate to become dense, discolored, and grow irregularly in thickness rather than length.
Age-related changes also play a significant role in this nail distortion. As a person ages, the rate of nail matrix turnover slows down, which results in the accumulation of dead keratin cells and a corresponding increase in nail thickness. Poor circulation to the extremities, a common concern in later life or with conditions like peripheral artery disease, further impairs the nail’s ability to grow normally, exacerbating the thickening.
A fungal infection (Onychomycosis) is another frequent cause of the issue. The fungus invades the nail structure, causing debris buildup and stimulating the nail to produce more keratin, resulting in a thick, crumbly, and often yellowish or brownish appearance. Systemic health conditions, including psoriasis or certain arthritic disorders, can also manifest in the nails, leading to thickening and structural changes that push the nail plate upwards.
Immediate Steps for At-Home Management
For safe and immediate relief, the nail must be softened before attempting any trimming or thinning. Soaking the feet in warm water for about 10 to 15 minutes allows the hard keratin layers to absorb moisture, which makes the nail more pliable. After soaking, thoroughly drying the feet is important to prevent the growth of any fungal organisms.
When trimming a thickened toenail, specialized, heavy-duty nail nippers are recommended, as standard clippers may not be strong enough and can cause the nail to split. The technique involves making small, straight cuts across the nail tip, avoiding the temptation to cut down the corners or curve the edges. Cutting straight across prevents the formation of sharp edges that can press into the skin, reducing the risk of an ingrown toenail.
To reduce the pressure caused by the upward growth, the nail plate’s thickness should be gently filed down. This thinning can be achieved using a coarse emery board or a specialized electric nail grinder. The goal is to reduce the thickness without causing heat or pain, which may require multiple short sessions over several days. Reducing the bulk of the nail instantly alleviates pressure on the underlying nail bed and improves comfort in shoes.
If a mild fungal cause is suspected, over-the-counter topical treatments containing ingredients like terbinafine or clotrimazole can be applied. These products may slow the progression of the fungus, but they often struggle to penetrate the full depth of a severely thickened nail plate. Consistent application is necessary, and patience is required since toenail growth is a slow process.
The most effective long-term home management involves selecting appropriate footwear. Shoes must feature a wide, deep toe box that provides ample space for the toes to move freely without compression. This prevents the constant micro-trauma that triggers abnormal growth and reduces the pinching sensation from pincer nails. Opting for breathable materials also helps keep the feet dry, creating an environment less conducive to fungal proliferation.
Professional Diagnosis and Treatment Paths
A consultation with a podiatrist or dermatologist is necessary if the nail becomes painful, shows signs of infection (redness, swelling, or pus), or if at-home care proves ineffective. These professionals can accurately diagnose the underlying cause before starting treatment. Diagnosis often involves taking a nail clipping or debris scraping for a laboratory test, such as a potassium hydroxide (KOH) examination or a fungal culture, to confirm the presence and type of fungal organism.
For conservative care, the professional will perform medical debridement, which is the mechanical reduction of the nail’s thickness. Using sterile, high-speed rotary tools, often referred to as a podiatry drill or a Dremel, the doctor safely thins the nail plate, instantly relieving pressure and making the nail easier to manage. This procedure is generally painless and is often repeated periodically for chronic cases of severe thickening.
If a fungal infection is confirmed and is deep-seated or affects multiple nails, an oral medication like terbinafine may be prescribed. This systemic treatment is highly effective because it reaches the fungus through the bloodstream, but it requires a commitment of 6 to 12 weeks for toenails. Due to the potential for side effects, including rare liver complications, blood tests are typically performed before and during the treatment period to monitor liver function.
For chronic, severe cases of upward growth, particularly pincer nails or Onychogryphosis that cause persistent pain or recurrent infection, a minor surgical procedure may be recommended. One common approach is a Partial Nail Avulsion with a chemical matrixectomy. This procedure involves removing a portion of the nail plate, followed by applying a chemical agent, such as phenol, to permanently destroy the nail matrix cells. The aim is to prevent the abnormal portion of the nail from growing back, effectively narrowing the nail plate and resolving the curvature.