What you need to know about toenail infections

What are the common causes of toenail infections that cause a person's toenail to fall off?

                    

There are several causes for nails falling off. It can either be attributed to fungal infections, trauma, psoriasis, or nutritional deficiencies. 

If a fungal nail begins to grow between the nail and the nail bed, it runs the risk of your toenails falling off. However, before this occurs, you can take precautions to prevent this from happening. First and foremost, you want to keep your feet dry. You also want to make sure you are changing your socks daily. These two factors have the ability to create a dark, warm, and moist environment where microscopic organisms thrive. 

Nail trauma is another reason why your nail may fall off. When you repeatedly stub your toes or drop heavy objects on them, it can cause a subungual hematoma, or a bruise under the nail bed. The nail slowly starts detaching itself because the blood vessels under your nail separates it from the nail bed.

When you have psoriasis, it can cause your nails to crumble and break off. Because it is an autoimmune disease, it affects your keratin levels, which is a vital protein needed for your nails to grow healthy and strong. 

Finally, it is also important to understand that poor nutrition can also cause your nails to fall off. When you lack calcium or vitamins A, B6, C, and D, it can lead your nail to grow thin and brittle. This can open up the possibility of your nails being more susceptible to trauma, as well as crumbling off.

With all of that being said, you should always keep an eye out for signs of damage to your nails. Be on the lookout for discolored nails, a foul smell, thicker toenails, an unusual toenail shape, or brittle nails. If you start to notice these symptoms, reach out to your podiatrist to see what the best option for you may be.

                    

When a toenail falls off or must be removed due to an infection, what steps should a person take to keep the area safe and clean? What needs to be done to clear up and care for the infection?

 

Epsom salt and warm water soaks can help drain all the infection and quicken the healing process. You should also cover it with an antibiotic or neosporin and band aid to protect the area while you are waiting for your nail to grow back. Wrap the area with gauze or a bandaid when you’re out and about, but take it off before going to bed in order to let it breath.  

 

What can and can't a person with a toenail infection do? For example, is it okay for them to wear socks and shoes if the infected area is wrapped up? Or do they need to stay home until it's completely cleared up? Can they walk around or play sports? What about showering?

Changes in shoe gear, activity levels, or showering cannot address a toenail infection on its own.  The more appropriate question is what type of infection does a person have as this will determine the appropriate treatment and what can be done.  Is the infection bacterial or fungal? A fungal infection is characterized by thickened, discolored, and dystrophic nails and these changes occur gradually over time.  A bacterial infection of the toe on the other hand typically occurs more acutely and aggressively when someone develops an ingrown nail or gets injured by a pedicurist after going to a nail salon.  Bacterial infections are more painful than fungal infections and are characterized by increased redness, swelling, heat, and are often accompanied by purulent discharge.  

Both infections are treated differently.  Fungal infections of the nail are most effectively treated by a combination of methods: prescription topical antifungal gel applied directly to the skin of the foot, a prescription topical antifungal nail lacquer applied directly to the nail, as well as use of an oral antifungal medication for three months.   In my practice I have tremendous success treating fungal nails with Clear-A-Nail, a quick and painless procedure that only takes a 30 minute trip to the office. In this procedure, I create tiny holes the width of four human hairs in the nail plate using Controlled Micro Penetration (CMP.) These holes allow topical treatment to reach in higher concentration without causing any pain or soft tissue injury. This can clear up the nail infection as quick as three months.            

Bacterial infections are caused by an ingrown nail which means that in order to get rid of the infection, the ingrowing portion of the nail must be removed by a foot specialist.  Once the nail is removed, topical antibiotic is applied to the toe with a light dressing and you may be instructed by your doctor to wear a surgical shoe for pressure relief. You will then soak your feet in lukewarm water with epsom salts for 15 to 20 minutes and then apply neosporin and a bandaid to your toe twice daily.  Sometimes an oral antibiotic medication may be prescribed if the infection is severe. 

                    

How long does it typically take for a toenail infection to clear up?  

               

A bacterial infection will typically resolve in 2 weeks after the ingrown portion is removed.  A fungal nail can resolve anywhere from three months when treated with combination therapy and Clear-A-Nail or up to a year without the procedure as toenails grow on average of 1 mm per month.   

 

What's the worst-case scenario if a person with a toe infection were out in public and stubbed that toe or someone stepped on it accidentally? Would they still be able to recover? Or would it make things worse?

 

When your nail is at its weakest, it is unable to protect your nail bed the way it should. The worst case scenario would be permanent damage which means it won’t grow back at all or it will grow back dystrophic. Fungal nail can be treated, unfortunately permanently disfigured nails cannot as the nail matrix also known as the root of the nail is permanently damaged.



Author
Dr. Miguel Cunha Dr. Miguel Cunha, founder of Gotham Footcare and a leading podiatrist in Manhattan, is a highly trained and skilled foot and ankle surgeon with experience treating a wide array of foot and ankle conditions from minor problems to complex reconstructive foot and ankle surgery. Dr. Cunha takes pride in having a genuine interest in each and every one of his patients while providing them the utmost compassion and exceptional care.

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