Your nails grow from the area under your cuticle and take months to grow out to the free edge where you would cut them to keep them short. Larger nails taking longer than the smaller nails to grow out to the free edge. Some of the changes you see may be temporary and you can see the nail recovering as it is growing from the cuticle area. These problems may not need any intervention, just keeping an eye on.
Nails can change their appearance for several reasons.
Trauma and bruised nails
Nails often change how they grow due to either frequent repetitive pressure, such as that from the toe cap of shoes or the ends of shoes that don’t fit that foot well, or from one-off trauma such as dropping a heavy item onto the toe(s). They may get a bruise under the nail due to either of these sorts of events. This may appear as a darkened area under the nail and the end of your toe may feel more tender than usual. Usually the bruise will gradually grow out as the nail grows, starting to look normal near the cuticle after a few weeks and growing out until eventually the nail appears normal again. Where the bruise formed under the nail a pocket of blood may lift the nail and as it grows out the nail may feel loose where it has separated from nail bed. If it feels like the nail may catch on bedding, socks etc the nail can either be cut back to where it feels a bit more firmly attached or can be taped down over the end so that it does not catch as much. Both actions reduce the risk of the nail catching and pulling away from the remaining attachment causing an injury. As the nail grows out this situation will sort itself out as the free edge is cut and new nail replaces the old nail. If the damage to the nail was quite severe a new nail may replace the old nail but grow underneath the old nail. As it grows out it will lift the old nail until it is removed completely. It is safe to just monitor this natural process but if needed loose nail can be cut away and the remainder taped if it is danger of being pulled off by socks or bedding etc. Where possible, whilst your foot recovers it is best to prevent ongoing damage so it is a good idea to identify the cause by checking the fit of your shoes or review what could be done to prevent a re-occurrence.
Thickened nails
Frequent repetitive pressure, such as that from poor fitting footwear, can also cause nails to thicken. This will happen gradually over a long time but the early signs may be if toes or toenails feel painful once the shoes have been removed and the toes have a bit more space to allow a better blood flow and you may then notice the pain. Good blood flow is essential to allow any short term damage to be repaired by the body but if this process is frequently repeated you may notice changes such as painful nails (as above) or blisters, corns, callus or sores forming on the skin where it rubs on the shoe. If you find that your toes are hurting when wearing shoes or when you take them off it would be a good idea to check whether they are big enough by using a cardboard template of your feet (made by drawing around your feet whilst stood on the cardboard with your weight evenly on both feet) to see how they fit in your shoes. Once you have cut out the template of your foot, place it in the shoe and if the cardboard does not lie flat in the shoe with a space the width of your thumb (approximately an inch) beyond your longest toe then the shoe does not fit your foot properly. The shoes should also have a fastening to keep your foot back from the end of the shoe so your foot isn’t sliding into this space and hitting the end of the shoe. You may also have to consider how deep the toe cap on the shoe is as nails can sometimes rub on the tops of shoes if they are a bit too shallow, especially if they are near the end of the shoe. By making sure you have enough room at the end of the shoe this ensures you still have some space when your feet swell, as they do naturally during the day and more markedly in warm weather, also you have enough space to accommodate different thicknesses of socks without developing problems. You may find reading our Footwear Leaflet useful if you have concerns about your shoes.
‘Ingrowing’ nails
People often talk about ingrowing toenails where a nail may be rubbing the skin at the side of the nail. Often this can be due to thick nails or nails that are involuted (they curve in towards the edges) rubbing on the top of the shoe where the toebox is a bit too shallow. This can easily be resolved by only wearing footwear with a deep enough toebox and long enough so that your nail/toe does not press on the top of shoes. Thick nails can also be filed on the top of the nail to reduce the thickness, but the cause of the thickening needs to be addressed too where possible. If this continues indefinitely the pressure can cause a wound beneath the nail (which would require treatment) or it can cause a true ingrowing toenail where the pressure causes the sides of the nail to break the skin there and cause a wound. The fit of the footwear and depth of the toebox is the best way of preventing this as it need not be a problem. If you have a recurring problem with wounds and infection despite taking preventative measures by following footwear advice then it may indicate that part or all of the nail is removed and a chemical applied to prevent it growing back. If you think this may be required you may want to read more in Advice about Nail Surgery.
Trouble cutting nails
Sometimes nails can just feel tough or uncomfortable to cut. If you are having this problem we often recommend filing nails with an emery board or other nail file. This can feel safer as there is less risk of cutting skin accidentally, cutting down the sides of nails and creating a problem or nails breaking off when pressure is applied. The file can also be used to take off some of the thickness that can be a problem – but do check the nail is thick and it is not just the shape of the nail bed (involuted). Filing can also be a good way to help someone else if you do not feel confident about cutting their nails. More advice may be available here.
Fungal nails
Sometimes it can be difficult to tell the difference between a nail which has become thickened due to trauma and a fungally infected nail because they may both appear thicker and have some discolouration. This is often because the nail can be weakened by trauma from footwear or activities like football and then develop a fungal infection when it comes into contact with infective fungal spores. A test can be conducted to see if a nail has a fungal infection but often it can be just as useful to treat it as though it has a fungal infection as it is likely to be prone to one if it is showing changes. A fungally infected nail where the infection has not yet reached the base (cuticle) of the nail can be treated with a nail lacquer available from the pharmacy. By following the manufacturer’s instructions and filing the nail back to the unaffected part of the nail and then applying the lacquer you can treat the infection and prevent progression. If the infection has reached the base of the nail then you may want to discuss other options with your GP. A fungally infected nail may not present significant problems but the spores from the nail can lead to other nails being infected if they are vulnerable and can also lead to repeated skin infections. If you are treating your nail you should also treat shoes and socks to prevent re-infection. For more information about fungal infections, including preventative advice please read Fungal Infections leaflet.
Weeping nails
If you have a nail that has started to produce a discharge or blood that is leaking from under a nail or the sides of the nail this suggests that you have developed a wound. All wounds should be kept covered with a sterile dressing to reduce the chance of infection. If you think the wound was caused by shoes then wearing another pair that has more room would be advisable. If you think the wound may heal in a few days you could follow the advice here. If the wound is not healing then you may need to see a podiatrist for advice. If you are already known to the Podiatry Service and are on the PIFU list you should read If you are a PIFU patient and contact the Service to arrange an appointment.