Toenails serve as protective shields for the delicate tips of our toes, safeguarding the underlying skin and bone from injury. They are composed of keratin, the same protein found in hair and skin, providing a hard, resilient covering. Beyond protection, toenails also contribute to the sensitivity of our toe tips and assist with balance by enhancing sensory feedback from the ground.
The Regrowth Process
When a toenail detaches, the body typically initiates a regrowth process, with a new nail forming from the nail matrix. This matrix, located beneath the skin at the base of the nail, continuously produces new cells that harden and form the nail plate. The process of toenail regrowth is slow compared to fingernails, which grow approximately twice as fast.
On average, a lost toenail can take between 12 to 18 months to fully regrow. Initial signs of new growth may become visible within two to three months, with the nail typically halfway grown at six to nine months. This slower growth rate is attributed to reduced blood flow to the toes compared to the fingers, and constant pressure exerted by footwear and walking.
Several factors can influence the speed and success of toenail regrowth. Younger individuals experience faster nail growth than older adults. Good overall health, proper nutrition, and efficient blood circulation contribute to regrowth by delivering necessary nutrients. Conditions like diabetes or poor circulation can slow the process, as can damage to the nail matrix itself.
Causes of Toenail Loss
Toenails can detach for various reasons, with physical trauma being a common cause. Dropping a heavy object on the toe, stubbing it forcefully, or repetitive impact from ill-fitting shoes can lead to injury. Such trauma can cause bleeding under the nail, known as a subungual hematoma, which creates pressure and can eventually lift the nail from its bed, leading to its detachment. This separation may not occur immediately but can happen several weeks after the initial injury.
Fungal infections (onychomycosis) are another frequent culprit behind toenail loss. They can infect the nail, causing it to become discolored, thickened, and brittle. Untreated fungal infections weaken the nail structure, causing it to separate from the nail bed and fall off. Skin conditions, like psoriasis, can also affect nail health. Psoriasis can cause skin cells to build up under the nail, leading to thickening, discoloration, and detachment.
Certain medical conditions and medications can also contribute to toenail loss. Underlying health issues like diabetes or peripheral artery disease can limit blood flow to the feet, making nails more susceptible to damage and detachment. Additionally, some medications, including certain chemotherapy drugs, retinoids, and even some antibiotics, can affect nail growth and strength, potentially leading to nail separation.
Caring for a Missing Toenail
When a toenail has fallen off, proper care of the exposed nail bed is important to prevent complications and support healthy regrowth. Gently clean the area with soap and water. Apply an antibiotic ointment and cover the nail bed with a clean, non-stick bandage to protect it and reduce infection risk. Change the bandage daily and whenever it becomes wet, continuing for 7 to 10 days until the underlying skin hardens.
Wear appropriate footwear to minimize irritation and prevent further damage during regrowth. Open-toed or roomy, breathable shoes reduce pressure on the exposed area. Avoiding tight shoes and ensuring proper foot hygiene also helps prevent new infections. If only part of the nail has detached, trim any loose or jagged edges to prevent snagging, but avoid forcing off any still-attached portions.
Consult a healthcare professional, like a podiatrist, if there are signs of infection (increased pain, redness, swelling, pus, or fever). Persistent pain, non-stopping bleeding, or concerns about abnormal regrowth also require professional evaluation. A podiatrist can assess the cause of nail loss, treat underlying conditions like fungal infections, and guide healthy nail regrowth.