Why Does My Toenail Grow Upwards? Causes and Fixes

A toenail that tilts, lifts, or curls upward instead of lying flat against the nail bed is almost always a sign that something has disrupted how the nail is produced or where it sits on the toe. The causes range from simple shoe-related trauma to a bony growth underneath the nail, and each one calls for a different fix. Because the direction and location of the upward growth matter, identifying the right cause is the first step toward getting rid of the problem for good.

Onychogryphosis, the Classic Upward-Curving Nail

If your toenail has become dramatically thick, discolored yellowish-brown, and is curving upward and then off to one side, you’re likely looking at a condition called onychogryphosis. The nail plate thickens, elongates, and develops an exaggerated curvature that initially grows upward before deviating laterally toward the neighboring toes.¹ The visual result is sometimes called a “ram’s horn nail” because the shape can resemble a spiral horn. It’s most common in older adults, particularly those who have difficulty reaching their feet for regular nail care.

Several things drive onychogryphosis. Repeated low-grade trauma from tight shoes is a frequent contributor, especially when combined with poor circulation in the feet. Peripheral vascular disease, diabetes, and simple neglect of nail trimming all play a role. The nail matrix, the tissue under the cuticle that generates new nail cells, becomes damaged or uneven, producing nail material that is thicker on one side. That asymmetry is what causes the upward-then-sideways growth pattern rather than a smooth, flat advance toward the tip of the toe.²

For mild cases, regular podiatric trimming and filing with an electric burr can keep the nail manageable. Severe or recurring cases, though, often end up requiring permanent removal of part or all of the nail along with destruction of the underlying matrix so the distorted nail doesn’t grow back.

Trauma and Retronychia

A single stubbed toe or months of pressure from running shoes can do more than cause a bruise under the nail. When trauma disturbs longitudinal nail growth, the newly forming nail plate can lose its forward trajectory and start embedding backward into the proximal nail fold, the skin fold at the base of the nail. This is called retronychia, and it creates a distinctive appearance: the nail looks like it’s lifting or growing upward at the base rather than sliding smoothly forward.³

Retronychia tends to affect the big toenail and is more common in younger women, often because of footwear that repeatedly jams the toes. The proximal nail fold becomes swollen and inflamed, and the nail stops advancing toward the tip of the toe. In early stages, people often mistake this for a fungal infection or a simple ingrown nail, which delays the right treatment.⁴ The key distinguishing feature is that the thickening and inflammation are at the base of the nail, not at the sides or tip.

If caught early, switching to roomier shoes and protecting the toe from further impact may allow the nail to resume normal growth. More established cases require a procedure in which the old, stacked nail plates are pulled out from the proximal fold so the new nail plate underneath can grow forward unobstructed. It sounds dramatic, but the relief tends to be immediate, and the new nail usually comes in normally.

A Bony Growth Under the Nail

Sometimes the nail itself is perfectly healthy, but something underneath it is pushing it upward. A subungual exostosis is a benign bony overgrowth that forms on the tip of the bone inside the toe, typically the big toe. As the bump enlarges, it lifts and deforms the nail plate above it.⁵ Depending on its size and position, the nail can look like it’s tenting upward, growing at an odd angle, or digging into the surrounding skin as the deformed plate gets redirected.⁶

These growths usually develop after repetitive microtrauma to the toe, which is why runners, dancers, and people in steel-toed work boots see them more often. You can sometimes feel a firm, non-movable lump at the tip of the toe if you press gently. An X-ray will show it clearly. The exostosis won’t go away on its own; it needs to be surgically shaved down or excised. When the procedure is done correctly, recurrence is uncommon and the nail tends to flatten back out as it regrows over the now-smooth bone.⁷

Psoriasis and Subungual Hyperkeratosis

Psoriasis doesn’t just affect skin. When it targets the nail unit, it can produce a buildup of scaly, chalky material underneath the nail plate called subungual hyperkeratosis. That buildup physically lifts the nail away from the bed, making it look like it’s growing upward or coming unglued at the free edge. Other signs that point toward psoriasis as the cause include tiny pits on the nail surface, salmon-colored patches visible through the nail, and splinter-like hemorrhages running lengthwise.⁸

The loosening of the nail plate from the bed, known as onycholysis, often starts at the tip and works backward. It creates a pocket that traps moisture and debris, which can invite secondary fungal infection on top of the psoriasis, confusing the picture further. A dermatologist can usually distinguish psoriatic nail disease from a pure fungal infection by looking at the pattern of changes across multiple nails and checking for psoriasis elsewhere on the body.⁹

Treatment depends on severity. Topical corticosteroids or vitamin D analogs applied around the cuticle can help mild cases. Stubborn nail psoriasis may respond to systemic medications or biologic therapies used for skin psoriasis. The nail won’t look normal overnight; because toenails grow slowly, it can take six months to a year to see the full benefit of treatment even after the underlying inflammation is controlled.

Congenital Malalignment of the Great Toenail

Not every upward-pointing toenail is acquired. Some people are born with a nail plate that doesn’t line up with the bone underneath. Congenital malalignment of the great toenail is a condition in which the nail plate sits at an angle to the long axis of the toe, deviating laterally. It typically shows up in infancy or childhood and is considered heritable, though the exact genetic mechanism is still unclear.¹⁰ Cases have been documented in twins, reinforcing the genetic link.¹¹

Because the nail grows at an angle from birth, it tends to be thicker and more discolored than a normal toenail, and the edges may dig into the surrounding skin. Some children outgrow the problem as the toe grows and the nail matrix rotates into better alignment. Others do not, and in persistent cases a minor surgical procedure to realign the matrix can produce a normally growing nail. The condition is underdiagnosed because it’s often mistaken for a fungal infection or habitual trauma.

Fungal Infection as an Overlooked Cause

Onychomycosis, fungal infection of the toenail, is probably the single most common reason a toenail starts looking abnormal. While classic fungal nails are thick, crumbly, and yellow, severe infections can produce enough debris under the nail to push it upward, especially at the free edge. In some people the nail lifts away from the bed entirely. The visual overlap with psoriatic nails and even subungual exostosis is part of why getting a proper diagnosis matters before committing to a treatment plan.

A nail clipping sent for microscopy and culture can confirm fungus. Topical antifungal lacquers work for mild surface infections, but when the infection has invaded the nail bed enough to cause upward displacement, oral antifungal medication taken for several months is usually needed. Over-the-counter remedies and home treatments like vinegar soaks lack strong evidence of clearing established infections, though they may help prevent reinfection after a successful course of prescription therapy.

Non-Surgical Fixes and Bracing

For toenails that are curving upward or inward but don’t require outright removal, nail bracing can be surprisingly effective. A thin wire, composite strip, or spring-like device is bonded across the nail surface and gradually flattens the curvature over weeks to months, similar to how orthodontic braces straighten teeth. The procedure is painless, requires no anesthesia, and lets you keep wearing your normal shoes.¹²

Bracing works best when the underlying cause is mechanical, such as curvature from chronic pressure or a mildly misaligned growth pattern. It won’t help if the problem is a bone spur underneath or active psoriasis inflaming the nail bed. A podiatrist or dermatologist can usually tell quickly whether your nail is a candidate for bracing or whether you need something more involved. The main downside is that braces need to be adjusted or reapplied every few weeks, so you’re committing to a series of office visits.

Beyond bracing, simpler everyday habits can keep a mildly upward-growing nail in check:

• Trim straight across: Rounding the corners encourages the edges to grow into the skin, worsening any upward deflection at the sides.
• Wear shoes with a roomy toe box: Constant pressure on the nail tip is one of the most common triggers for abnormal growth patterns.
• Keep nails at a moderate length: Too short invites the surrounding skin to override the nail edge; too long increases leverage and the chance of catching and bending the nail.
• Moisturize the cuticle area: Dry, rigid tissue around the nail fold doesn’t accommodate growth well and can redirect the nail plate.

When Surgery Becomes the Best Option

Surgery enters the picture when conservative measures fail or when the structural cause demands it. The type of procedure depends on what’s going on:

• Partial nail avulsion with matrixectomy: The offending portion of the nail is removed and the corresponding section of the nail matrix is destroyed, usually with a chemical like phenol. This prevents regrowth of the problematic strip while preserving the rest of the nail. It’s the standard approach for recurring ingrown nails and works well for edges that persistently curl upward into the skin.
• Total nail avulsion: The entire nail is removed, sometimes with matrix destruction if permanent removal is the goal. This is reserved for severely deformed nails, particularly advanced onychogryphosis, where the nail is beyond reshaping.
• Retronychia surgery: The stacked, impacted nail plates are extracted from under the proximal fold. The new nail growing underneath is left intact and typically grows forward normally once the obstruction is cleared.⁴
• Exostosis excision: The bony bump is accessed through an incision at the tip of the toe or through the nail bed, shaved down or removed, and the nail bed is repaired. Functional and cosmetic outcomes are generally good, and recurrence is low when the growth is fully removed.⁷

Recovery from most toenail surgeries involves a few weeks of limited activity and protective bandaging. Infection risk is generally low because the toe has good blood supply, though people with diabetes or peripheral artery disease heal more slowly and need closer follow-up.

When an Upward-Growing Nail Needs Urgent Attention

Most causes of an upward-growing toenail are benign and fixable. But a few warning signs should prompt a faster trip to the doctor rather than a wait-and-see approach. A dark streak or pigmented band under the nail that appears without obvious trauma can be a sign of subungual melanoma, a rare but serious form of skin cancer. Subungual melanoma accounts for a small percentage of all melanomas, but it’s disproportionately dangerous because it tends to be misdiagnosed as a bruise, chronic trauma, or fungal infection, delaying treatment.¹³

Beyond discoloration, other red flags include a wound under or beside the nail that won’t heal, a mass that keeps growing despite treatment, bleeding from the nail bed without clear cause, and nail changes confined to a single digit rather than multiple nails. Psoriasis and fungus almost always affect more than one nail over time, so a dramatic change in just one toenail is worth investigating more aggressively.

Even when the cause turns out to be something harmless, getting a clear diagnosis early means you can match the right fix to the right problem. Treating an exostosis with antifungal cream, or treating retronychia by trimming the nail tip, won’t get you anywhere. A podiatrist or dermatologist can usually identify the cause with a physical exam and, when needed, imaging or a nail clipping for lab analysis, setting you up for a treatment that actually addresses why the nail is growing the wrong way.