The fifth toenail sometimes grows in a direction that seems unnatural—thickening and lifting away from the toe. This condition, where the nail plate becomes misdirected, is a common inquiry. While the appearance of a thickened, upward-growing nail may be concerning, it is rarely a sign of a serious medical issue. This change often relates to mechanical forces acting on the toe, altering how the nail-producing cells function.
Primary Reasons for Upward Growth
The primary cause for the fifth toenail to grow upward is chronic, repetitive microtrauma, often caused by daily friction from footwear. The pinky toe is highly susceptible to compression and rubbing against the inside of shoes, especially those with a narrow toe box. This constant pressure irritates the nail matrix, the tissue responsible for growth. In response to persistent trauma, the matrix produces a nail plate that is thicker and denser (onychauxis).
This mechanical stress can also damage the nail bed, causing the nail to detach slightly or change its angle of growth, pushing it upward over the tip of the toe. The upward curve is a consequence of the nail plate’s overgrown nature and the physical constraint placed upon it.
For some individuals, upward growth results from anatomical or genetic factors, rather than external pressure alone. The fifth toenail is naturally small and sometimes vestigial, meaning it is underdeveloped. It may have a nail matrix that is vertically implanted or oriented differently from the start. This hereditary predisposition can lead to a natural growth pattern that directs the nail plate upward, sometimes referred to as “vertical implantation of the nail of the fifth toe.”
Improper trimming techniques also contribute to the problem by encouraging incorrect growth. Cutting the nail too short, particularly by rounding the corners, can trigger a protective reaction. This practice allows the surrounding skin to push against the nail matrix, causing it to produce an abnormally thick or misshapen nail that lifts. The goal of trimming should be to relieve pressure, not to eliminate the visible nail plate entirely, which exacerbates the issue.
Proper Care and Prevention Strategies
Managing an upward-growing pinky toenail begins with adopting a precise and consistent trimming technique. It is best to soak the feet in warm water for five to ten minutes to soften the nail before trimming, making the thickened plate easier to cut. Use a proper toenail clipper to cut the nail straight across, avoiding the temptation to round the edges or cut into the corners.
The nail should be cut so that it is even with the tip of the toe, leaving a small amount of white nail visible to prevent irritation of the skin underneath. After trimming, gently use a file or emery board to smooth any sharp points or rough edges. This simple action prevents the nail from catching on socks or shoes and reduces the risk of further injury to the surrounding skin.
Selecting appropriate footwear is important for preventing the recurrence or worsening of this condition, as mechanical pressure is a central cause. Choose shoes that feature a wide, deep toe box, ensuring ample space for the pinky toe to move without compression. Avoiding shoes that taper sharply at the front helps eliminate constant friction on the outer edge of the foot.
If the nail has become significantly thickened, filing the surface can help reduce its bulk and upward lift. Gentle filing with a coarse nail file two to three times a week can thin the keratin layers. Applying a specialized urea-based cream can also help soften the dense nail plate, making it easier to manage and trim at home.
Recognizing When Medical Attention is Needed
While most cases of upward-growing pinky toenails can be managed with home care, certain symptoms indicate a need for professional medical evaluation. You should consult a podiatrist or dermatologist if you experience severe pain, throbbing, or an inability to walk comfortably due to the nail. These signs suggest that the underlying issue may be progressing beyond simple thickening.
Signs of infection, such as increased redness, swelling, warmth, or the presence of pus around the nail, require prompt medical attention. An infection can develop if the lifting nail plate causes a break in the surrounding skin, allowing bacteria or fungi to enter. People who have underlying health conditions like diabetes or poor circulation should seek professional care for even minor nail changes, as they are at a higher risk for complications.