Thickened Toenails - Riverside Podiatry

People often ask us here at Riverside Podiatry, why are my toenails so thick? And what can I do about it? Because of this we have decided to clear the air and explain it for you. Although there are various causes for thickened toenails there is one overarching principle that is almost always implicated. TRAUMA TRAUMA TRAUMA! Whether it’s repetitive micro trauma from ill-fitting footwear, an infection that destroys the integrity of the nail and gives it a thickened appearance or macro trauma from accidentally dropping a hammer onto your toe, thickened toenails are more often than not associated with trauma. Trauma either temporarily or permanently damages the underlying nail bed and causes an abnormal growth pattern from the base of the nail where the nail is formed.

Micro trauma:

Micro trauma usually comes from footwear that is either too small or too large or, believe it or not, the correct size footwear just worn in an incorrect way. Micro trauma is more likely to cause permanent damage/changes to the nail growth pattern (e.g. thickened toenails) compared with macro trauma.

Micro trauma from footwear that is too small occurs when the digits are compressed in the shoes. This occurs every time the foot impacts the ground and attempts to splay the digits (a normal part of the cushioning process of your feet when walking) – the shoe pressurises the digits and stresses the nail bed and nail growth matrix which warps its shape. If permanent damage is sustained or it is left unattended in the early stages of the process it may become quite difficult to resolve and may require ongoing maintenance with your podiatrist.

Micro trauma from footwear that is too large occurs when the foot slips in the shoe or the shoe twists and the toes contact the upper lining of the shoe. This develops a similar pressure as mentioned in the small footwear problem above. Naturally it follows that this will have a similar effect. The nail will become thick and distorted in its growth pattern.

Correctly sized footwear can cause micro trauma when the footwear is incorrectly worn through either a lack of fastening, inappropriate techniques or use of the fastening already on the footwear. This will inevitably increase the friction and torsion of the foot in the shoe and can lead to damage to the nail bed and nail matrix similar to that of the ill-fitted footwear.

Macro trauma:

Macro trauma occurs when a nail or the distant part of the digit, just before the start of the nail, has been struck with a heavy object or traumatised through accidental kicking or catching the nail when walking. Similar to inappropriate footwear the damage is sustained to the nail bed and nail growth matrix which leads to abnormalities in the immediate shape and sometimes the ongoing growth pattern of the nail. This may involve under-nail bruising and pain and the nail may completely separate from the nail bed and fall off.

Fungal nail:

Another form of thickening occurs with that of fungal nail infections. This involves fungal spores infecting and disintegrating the nail plate itself. It is associated with a brittle deterioration of the nail plate and damage to the underlying nail bed. It is often confused with direct trauma induced thickening of the nail and therefore incorrectly treated.

Systemic problems:

Rarer causes for development of thickened toenails include medication, systemic problems such as complex respiratory conditions or even some autoimmune disorders such as psoriasis. These factors can lead to brittle or damaged nails, thickened nails or abnormal growth patterns.

When should you call the podiatrist:

It’s worth visiting with a podiatrist to determine the cause of your thickened toenails and what can be done to manage or resolve them. Our friendly staff at Riverside Podiatry will be happy to help if you need further information or interested in getting your thickened toenails assessed.

When to call: