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Common Toenail Problems

By Dr. Tina M. St. John ; Updated July 18, 2017

With a high level of physical exposure, toenail problems occur frequently. Infections prove particularly common and may affect the nail bed or the surrounding skin. Toenail injuries also commonly occur. Home treatments often suffice for minor toenail problems. Medical intervention provides relief for chronic infections and significant toenail injuries.

Ingrown Toenails

An ingrown toenail occurs when abnormal curvature causes nail growth into the skin at the nail’s outer edge. Ingrown toenails typically cause tenderness, redness and swelling of the affected skin. The American College of Foot and Ankle Surgeons reports that the big toe proves the most common site for ingrown toenails. Infection of an ingrown toenail can complicate this common nail disorder. Factors that contribute to the development of an ingrown toenail include nail injury, trimming the nails too short or at an angle, and shoes that are exceedingly short or tight.

Paronychia

Trauma to the skin around the nail opens a route for infection around the nail, a condition termed paronychia. Aggressive cuticle trimming or pushing the cuticles back too far during a pedicure or artificial toenail placement, and minor cuts and scrapes of the skin around the toenails may lead to the development of infection. Symptoms of acute paronychia include swelling, redness and tenderness around the affected nail. Pus commonly accumulates in the skin fold surrounding the nail. In a 2008 review article published in “American Family Physician,” Dr. Dimitris Rigopoulos and colleagues report that abscess formation and chronic paronychia may develop with untreated acute infections. An abscess represents a pocket of infection and inflammatory cells, which may cause separation and loss of the toenail.

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Fungal Infection

Fungi commonly infect the toenails, a condition called onychomycosis. The American Podiatric Medical Association explains that the infection develops in the nail bed, the tissue underneath the toenail. White marks on the toenail and slowly progressive discoloration of the nail typically develop. Affected toenails thicken with time, and the infection can spread from one toenail to others. Distortion of the toenails typically leads to pain when wearing closed-toed shoes. Factors that increase risk for the development of onychomycosis include poor foot and leg circulation, chronically wet or damp feet, diabetes mellitus, a weakened immune system and advancing age. According to MayoClinic.com, a six to 12-week course of prescription antifungal medication proves the most effective treatment for toenail fungal infection.

Subungual Hematoma

Dropping an object on the toe, stubbing the toe and other direct blows can cause bleeding in the nail bed, or subungual hematoma. Significant bleeds may cause a pressure buildup under the toenail, leading to throbbing pain. Information provided by InteliHealth.com, in collaboration with Harvard Medical School, recommends medical evaluation of a subungual hematoma involving more than 50 percent of the affected nail.

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