Why Do Your Toenails Fall Off? Common Causes

Toenail detachment, or onycholysis, occurs when a toenail lifts from its underlying nail bed. While unsettling, it is often a symptom of an underlying condition rather than a standalone problem. Understanding its causes can help in addressing the issue and preventing future occurrences.

Physical Trauma and Pressure

Acute injuries, such as stubbing a toe forcefully or dropping a heavy object, can cause immediate damage to the nail and nail bed. This can lead to bleeding underneath the nail, known as a subungual hematoma. The accumulation of blood creates pressure that lifts the nail plate from its bed, causing it to separate and fall off.

Chronic, repetitive microtrauma also contributes to toenail detachment. Activities like long-distance running, hiking, or wearing ill-fitting shoes exert sustained pressure or friction. Shoes that are too tight press against the nail, while loose shoes cause toes to repeatedly hit the front. This constant, minor damage gradually weakens the nail’s attachment to the nail bed.

Infections and Underlying Health Conditions

Infections and systemic health conditions can also lead to toenail loss. Fungal infections, particularly onychomycosis, are a frequent cause. Fungi can grow beneath the nail, causing it to thicken, discolor, and become brittle. As the infection progresses, the fungal growth can lift the nail plate from the nail bed, resulting in detachment.

Severe bacterial infections can compromise nail integrity, though they are less common causes of detachment than fungal infections. Certain systemic diseases can also affect nail health. Psoriasis, a chronic autoimmune condition, can directly impact the nails, causing pitting, discoloration, and separation from the nail bed. The disease can lead to a chalky substance accumulating under the nail, further contributing to its lifting.

Thyroid disorders, both an overactive (hyperthyroidism) and underactive (hypothyroidism) thyroid, can manifest in nail changes, including onycholysis. These conditions can affect nail growth rate and overall nail quality, making them more prone to detachment. Peripheral artery disease (PAD), which involves reduced blood flow to the extremities, can impair the delivery of oxygen and nutrients to the nails, leading to slow growth, brittleness, and potential detachment. Additionally, severe iron deficiency can result in brittle nails, which may contribute to detachment. Diabetes can also increase the risk of toenail problems, including infections and poor circulation, which can indirectly lead to nail loss.

Medication Side Effects

Certain medications can have side effects that result in toenail detachment. Chemotherapy drugs are particularly well-known for causing various nail changes, including loosening or shedding of the nail plate. The incidence of onycholysis can vary with specific chemotherapy agents, with some taxanes like docetaxel being frequently implicated.

Other drug classes may also contribute, though less commonly. These include some antibiotics, especially tetracyclines and fluoroquinolones, and certain nonsteroidal anti-inflammatory drugs (NSAIDs). Retinoids, derived from vitamin A, have also been noted to cause nail changes, including thinning and detachment. These medication-induced nail issues typically resolve once the drug is discontinued, though complete nail recovery can take several months due to the slow rate of nail growth.

When to Seek Medical Advice

Consulting a healthcare professional is advisable if toenail detachment occurs, especially with specific symptoms or an unclear cause. Seek medical attention if the detachment involves severe pain, swelling, redness, or pus, as these indicate an infection. Signs of infection warrant prompt evaluation to prevent further complications.

It is also important to seek professional advice if the cause is unknown, if it is a recurring issue, or if you have underlying health conditions like diabetes or a compromised immune system. Individuals with these conditions may be at higher risk for complications. A healthcare provider can accurately diagnose the underlying cause and recommend appropriate treatment to ensure proper healing and minimize future problems.