What To Do When Your Toenail Is Falling Off

Fungal infections under the toenail 

A fungal toenail infection, known as onychomycosis, can have various causes. The warm and moist environment inside your socks is often a perfect climate for fungi to thrive. You can be exposed to fungi by walking barefoot, sharing items such as footwear and nail tools, or coming into skin-to-skin contact with someone with a fungal infection.  

Certain risk factors and health conditions can make you more likely to develop toenail fungus. Athlete’s foot can morph into a fungal infection under the nail and diabetes can increase the risk of a fungal infection by restricting circulation in your feet. 

Whatever its source, a fungus growing between your toe and its nail can erode the connective tissue between the two, eventually resulting in complete toenail loss. 

Symptoms of a fungal nail infection 

Signs of infection usually include discoloration, thickening, and nail brittleness. You may also experience: 

• A flaky surface 
• White or yellow streaking on a toenail 
• Pitting 
• Crumbling on the edge of the nail 
• An unpleasant smell 

How to prevent fungal toenails

Proper foot care can increase your chances of avoiding fungal infections. Things like keeping your feet dry, changing your socks frequently, wearing shoes with ventilation, keeping your toenails trimmed, disinfecting your nail clippers, and wearing protective footwear in damp communal areas, like spas or locker rooms, can help prevent infection and ultimately keep your toenails from falling off.  

How are fungal toenails treated?

A fungal infection under a toenail can be stubbornly resistant, so a permanent cure can be a lengthy process.  In mild cases, an over-the-counter antifungal nail polish may solve the problem. However, most courses of treatment for moderate to severe fungal infections include oral or topical antifungal medications. 

Laser therapy is also an effective treatment for fungal toenails. In rare cases, the fungus may be so pervasive and resistant that a permanent resolution may require surgical toenail removal. See your podiatrist at Dr. Bob for the treatment appropriate for your particular condition. 

Psoriasis 

Psoriasis is a skin condition caused by the immune system mistakenly attacking healthy skin cells, leaving scaly red patches. It usually appears on surface skin but can also affect the area under your toenails. Nail psoriasis can cause a scaly build-up of skin cells under the toenail. Eventually, the pressure can separate the nail from its bed. 

The symptoms of psoriasis under a toenail are similar to those of a fungal infection, so an accurate diagnosis requires the attention of a podiatrist. Medicated creams can be prescribed to alleviate the symptoms, and phototherapy, involving intense spectrums of light, is sometimes helpful. 

Blows to the toes 

Trauma can also cause a detached toenail, either by a sudden harsh stubbing or constant irritation over time. If you bang your toenail hard enough or often enough, that trauma can cause a toenail to fall off, either suddenly and violently or gradually. 

Toenail avulsion, where the nail separates from the nail bed, can occur in several ways, such as during contact sports, from a falling heavy object, or a particularly harsh stubbing. Even if your toenail doesn’t immediately detach, any sudden force on a toe (usually the big toe) can cause ruptures of blood vessels in the nail bed.  

The accumulation of blood (called a subungual hematoma) between the toenail and its nail bed will cause a dark blue or black toenail. As the blood continues to collect under the nail, the increasing pressure will gradually detach the toenail. This process can take several weeks. 

The constantly repeated impact of a toe hitting the front of a running shoe can also result in a toenail becoming detached. The most effective way to prevent toenails from falling off while running is to make sure that you select proper running shoes that are neither too short nor too long.