Thickening Toenails: Causes and When to Seek Medical Advice

Thickening of the toenails?

After wearing new shoes on a hike, my toenail became bruised and turned black, eventually falling off.
When it grew back, it became thicker.
Should I be concerned about any underlying issues, and which specialist should I see?

Xiao Xue, 40~49 year old female. Ask Date: 2000/11/21

Dr. Hong Hongchang reply Internal Medicine

Nail bruising or loss due to injury may be caused by wearing ill-fitting shoes.
It is generally not a serious concern for the body; however, it is important to avoid infection and wear appropriate footwear.
If there are any questions, a consultation with a general surgery clinic is recommended.

Reply Date: 2000/11/21

More Info

Thickening toenails can be a common issue, often caused by a variety of factors, including trauma, fungal infections, or underlying health conditions. In your case, it sounds like the initial trauma from wearing new shoes led to bruising and subsequent nail loss, which can disrupt the normal growth of the toenail. When a toenail grows back after an injury, it may sometimes appear thicker than usual, which can be a natural response to the trauma.

Causes of Thickening Toenails
1. Trauma: As you experienced, trauma to the toenail can lead to changes in its growth. The nail may thicken as a protective response to the injury.

2. Fungal Infections: Onychomycosis, or fungal nail infection, is a common cause of thickened toenails. This condition can cause the nail to become discolored, brittle, and thickened.

3. Psoriasis: This skin condition can also affect the nails, leading to pitting, discoloration, and thickening.

4. Other Health Conditions: Conditions such as diabetes, peripheral vascular disease, or thyroid disorders can lead to changes in nail growth and thickness.

5. Poor Foot Hygiene: Not keeping the feet clean and dry can lead to fungal infections and other issues that may cause thickening of the toenails.

When to Seek Medical Advice
You should consider seeking medical advice if you notice any of the following:
- Persistent Thickening: If the thickening continues or worsens over time.

- Discoloration: If the nail changes color (e.g., yellow, green, or black) or if there is any unusual discharge.

- Pain or Discomfort: If the thickened nail causes pain, discomfort, or difficulty in walking.

- Signs of Infection: If you notice swelling, redness, or warmth around the nail, which could indicate an infection.

- Underlying Health Concerns: If you have underlying health conditions, such as diabetes, that could complicate nail issues.

Which Specialist to See
For thickening toenails, you would typically consult a podiatrist, a specialist in foot and ankle conditions. They can assess the nail's condition, determine the underlying cause, and recommend appropriate treatment. If a fungal infection is suspected, they may take a sample for laboratory analysis to confirm the diagnosis and suggest antifungal treatments if necessary.

In some cases, if the thickening is associated with skin conditions like psoriasis, you might also consider seeing a dermatologist. They can provide specialized care for skin and nail conditions.

Conclusion
In summary, while thickening toenails can result from trauma, it is essential to monitor the condition and seek medical advice if you notice any concerning symptoms. A podiatrist is typically the best first point of contact for toenail issues, and they can guide you on the appropriate treatment based on the underlying cause. Maintaining good foot hygiene and wearing properly fitting shoes can also help prevent future issues with your toenails. If you have any further concerns or if the condition persists, do not hesitate to reach out to a healthcare professional for a thorough evaluation.

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