During the summer, we spend a lot of time in the open outdoors, wearing sandals and other open-toed footwear. However, in the situation that you have a dead toenail, it is only normal to be embarrassed and avoid social situations. After all, no one wants to look at a toenail that has a strange color, being cracked or even detached from the nail bed.
In this article, we will talk about the main causes of dead toenails, meaning onychomycosis and trauma. We will teach you about risk factors and also how to remove a dead toenail, in order to allow for a healthy one to grow back.
Onychomycosis, a main cause of dead toenails
When a toenail is affected by a fungal infection, it changes both its structure and its color. Often times, the initial infection is represented by a condition known as athlete’s foot, with the fungal infection spreading to the toenails. It is important to understand that fungi require a wet and moist environment to survive and develop. When such conditions are ensured, the fungus will develop and affect the health of the nail. Left untreated, it will cause the respective toenail to die.
Fungal infections can be of various types, depending on the fungus present on the surface of the skin. In the initial stage, the toenail suffers from discoloration, its structure modifying with the passing of time. Toenails that have been infected will also thicken, being more difficult to trim. At the same time, they might become brittle or crumbly, with no injuries being involved in the process.
Because of the fungal infection, toenails can present a distorted shape, curling or lifting from the nail bed. In some patients, they lose their natural luster, becoming dull in appearance. The more the infection invades the toenails, the more their color will change. This is the reason why dead toenails have a greenish-black discoloration, suggesting a severe fungal infection.
What are the risk factors associated with fungal infections?
The environment is the most important risk factor to take into consideration. Fungal microorganisms, such as dermatophytes, thrive in environments that are both warm and moist, such as public swimming pools, showers or locker rooms. They can also be found in lake water, so you need to be aware of that when swimming in such locations. Fungus easily infects objects of personal hygiene, as well as footwear, being easily transmitted from one person to the other.
If you have a minor injury or cut on the skin, the susceptibility to a fungal infection is increased. Combined with a warm and moist environment, such as one caused by excessive sweating, all the conditions for a fungal infection are guaranteed. For this reason, you have to follow excellent foot hygiene and do your best in keeping your feet dry and cool.
In the situation that you have impaired blood circulation at the level of the feet, you will also present a higher risk of developing fungal infections. Such changes are encountered in people diagnosed with diabetes, making them prone to severe fungal infections. Aging is considered a risk factor; as a person ages, the nails become thicker and the gap between the nail and the toenail bed increases, providing the fungus with an excellent place to develop. A weakened immune system can leave the body pray to fungal infections, as well as acute trauma, excess sweating or other infections.
The treatment of the fungal infection depends on the actual fungus responsible for the problem. The sooner the treatment is started, the lower the risk of the respective toenail dying is going to be. In the situation that the toenail has already died, having stopped from growing, the only solution is to remove it. Once the toenail has been removed, you will have to treat the underlying infection, using the topical treatment recommended by the doctor (medicated antifungal cream).
Injuries can lead to dead toenails as well
In a lot of situations, the dead toenails are caused by acute or repetitive injuries at the level of the foot. For example, in the situation that a heavy object is dropped on your toes, it is highly likely the toenails are going to suffer as well. In case of acute trauma, a blood-filled blister is going to form under the nail, causing it to become detached from the nail bed. As you will have the opportunity to see below, this has to be dealt with first, before removing the toenail.
Not only acute injuries can damage toenails, causing them to die but also repetitive trauma. For example, in runners or other professional athletes, the forefoot repeatedly strikes the shoe, causing the toenails to suffer. When other risk factors are added, such as excessive moisture and warmth, it is possible that the toenail will suffer from both the trauma and a fungal infection (higher risk of death). Unfortunately, in case of injuries, there are no treatments that can be taken; you will have to wait for the condition to solve on its own.
Dead toenail removal
If a blister has formed under the toenail as a result of injury, this must be dealt with first. The blood-filled blister will create a sensation of pressure, causing the injured toenail to become painful. Because of the blister, the toenail will detach itself from the nailbed. Before draining the blister, make sure to clean the toe, patting it gently. Drain the blister using a sterilized needle and apply a gauze bandage, allowing the skin to heal. Keep in mind that fungal infections do not cause blood-filled blisters to form.
Once the skin has healed, it is time to remove the dead toenail. According to a guide on dead toenail removal, first and foremost, you have to wash your toes, using warm water (preferably with soap). Dry them well and try to trim the upper portion of the dead toenail, as much as you possibly can. Now, it is time to remove a part of the toenail, stopping when you can no longer bear the pain. The revealed skin will be raw and tender, so you have to cover it up using a gauze bandage. Make sure to apply antibiotic ointment as well, in order to encourage healing and keep the risk of infection down to a minimum.
Allow the skin to heal before removing the rest of the nail (wait a couple of days). If you are patient, the removal of the final part of the nail will be less painful. Once you have removed the nail completely, clean the raw skin and apply antibiotic ointment, covering the affected toe with a bandage. You can use sterilized clippers in order to remove the dead toenail. Be prepared for some pain and bleeding, having sterile bandages close by. You can also take some non-steroidal anti-inflammatory medication or analgesics to deal with the pain.
What happens once you have removed a dead toenail?
As it was already mentioned above, the skin in that area will be raw and tender, requiring particular care until it heals. For this reason, you have to maintain excellent hygiene. Wash the area with warm and soapy water, then pat it gently dry and apply antibiotic ointment. Cover the raw skin with a loose bandage and avoid injuring the respective toe, until the skin heals and the new, healthy nail begins to grow.
It is important to allow the skin to breathe, as this will speed up the healing process. Avoid walking or engaging in strenuous physical activities, as this will bring a lot of blood in the area and prolong the healing process. Also, it is recommended to change the bandage each time you clean the raw skin. The bandage should be changed in case it gets wet or dirty, in order to keep the risk of infection down to a minimum.
If possible, avoid standing or spending too much time walking. You need to rest, in order to bring down the pain and inflammation. The best position for healing is with the legs elevated. You can also apply an ice pack wrapped in a towel, so as to improve the symptoms experienced.
As the new nail begins to grow, it is recommended to avoid wearing shoes that are either too narrow or tight (additional trauma to the nail). You might also want to wear closed-toe shoes for a period of time, in order to guarantee the nail bed the protection it needs to recover (especially if you are engaged in various physical activities or you are spending your time in the open outdoors).
Always remember that infection is a possible complication that can occur with removing a dead toenail; if you are experience severe inflammation or if the skin in that area is warmth and pulsating, you have to go to the doctor. The same goes in the situation if you see purulent discharge coming from the wound or if you are running a fever (sign of serious infection).
If a dead toenail is bothering you, do not waste any more time and visit the doctor. The specialist can help you remove the dead toenail and provide suitable treatment for the raw, exposed skin. If you have decided to remove the nail yourself, follow the advice recommended in this article and make sure to always keep the area clean and free of germs.
 How to remove a dead toenail (WikiHow). Retrieved from: http://www.wikihow.com/Remove-a-Dead-Toenail
Amy is a foot massage therapist that has worked with doctors specializing in podiatry while helping numerous clients through various foot conditions. She has reviewed 100s of related foot health products for plantar fasciitis, toenail fungus and more.