Thick Toenails: More Than Just Aesthetics?

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article-0-0AD0B992000005DC-863_468x286The thickening of the toenails occurs as a natural phenomenon as you begin to age, being accompanied by the hardening of the nail plate. However, it is possible that such changes are present in young people as well, being either caused by trauma or different infections (fungal or bacterial).

It is important to recognize such changes as early as it is possible, in order to seek out the right treatment and ensure that the nail stays healthy.

Presentation

Thickened toenails have a characteristic aspect, with the nail plate being modified and painful or sensitive to the touch. Because of the thickening and hardening, toenails can become difficult to cut. They are also more susceptible to infection, presenting other changes: modified color, foul odor, purulent collection. Depending on the cause, the above-mentioned changes can be temporary or permanent.

Diagnosis

The diagnosis of the thickened toenails is clinical in most cases. The doctor will analyze the aspect of the toenail, measuring the thickness of the nail plate, as well as other characteristic changes (discoloration, foul odor, purulent collection, pain or inflammation). Small samples are taken in order to confirm the presence of a bacterial or fungal infection. Blood tests and other further investigations might be necessary for the diagnosis of the underlying condition (such as diabetes).

Causes of thick toenails

Toenail fungus

One of the major causes for which toenails begin to thicken is fungal infection. The accumulation of fungi at the level of the nail can cause it to thicken and harden, turning a yellow or brown color at the same time. It is possible that a foul odor is present at the level of the affected toenail(s), along with purulent collection under the nail (sign of additional bacterial infection).

Bacterial infection

Even though they are not as common, bacterial infections can modify the appearance of toenails as well. These are often found in people who have ingrown toenails and they require antibiotic treatment. Upon successfully treating the bacterial infection, the nail generally returns to its normal, healthy-looking aspect.

Trauma

Thick toenails can be caused by major trauma, as it is the situation with a heavy object being dropped on the foot (the thickening can be permanent in such situations). Repetitive pressure on toenails can also constitute a form of trauma; this is often seen in those who wear inadequate shoes, with the toenails striking against the tip of the shoe. In time, this repetitive trauma can have a negative impact on the toenail, causing it to thicken, harden or even separate from the nail bed.

Repetitive injuries to the toenails are seen in professional athletes, including runners, soccer players and hikers. In general, each person who walks or runs a lot is at risk of developing thickened toenails. Professional ballerinas or dancers can suffer from such problems, as they spend a lot of time on their toes or dance in closed shoes (higher risk of injury).

There are a number of factors that can contribute to the problem, such as excess moisture, inadequate footwear (shoes too tight or too small in size) or choosing routes that put a lot of pressure on the foot (steep incline). Trauma can alter the biomechanics of the foot, which in turn can affect all the elements in the area, including the toes and the toenails.

Ageing

As our bodies begin to age, we go through a number of changes. Our tissues are no longer as well hydrated, this being obvious at the level of the toenails as well. Ageing also means accumulation of trauma, affecting the quality of the toenails. It is possible that toenails thicken because of metabolic changes and/or decreased blood flow in the area.

Underlying conditions

In many situations, the toenails begin to thicken, as the patient suffers from an underlying condition, such as: rheumatoid arthritis, psoriasis, eczema, cardiovascular disease or even cancer. In order for the nail to return to its healthy-looking aspect, the underlying condition has to be treated first and foremost.

Diabetes is one of the most common conditions that can lead to thickened toenails, among other changes. The poor circulation at the level of the feet is responsible for the thickened toenails (quality of the nails is affected in general).

According to a guide[1] on maintaining healthy feet for people with diabetes, established by The Society of Chiropodists and Podiatrists, thickened toenails are part of the clinical picture of this invalidating condition. When a person presents high blood glucose levels for a long period of time, damage can occur in different parts of the body, legs included.

If the blood vessels are damaged by diabetes, the blood supply to the feet is going to be affected as well, being reduced. This can affect the quality of the toenails, causing them to thicken. Apart from thickened toenails, the patient suffers from cold and pale feet; hair is absent in the area and the skin is both shiny and smooth. In this guide, patients are recommended to follow the “3 steps, 3 minutes” foot care routine: step one, check their feet; step two, wash them with warm soap and step three, use a nourishing moisturizer.

In a study[2] presented online by the American Diabetes Association, we are informed that patients who suffer from diabetes, also present a higher risk for mycotic infections. The fungal infection can be responsible for the thickened toenails, being much harder to treat in a patient who suffers from diabetes. The treatment often fails in the situation that the nail plate is too thick, the surgical removal being left as the only alternative.

Note: the fact that toenails have the tendency to thicken with age and also because of underlying conditions is confirmed in the Atlas of Nail
Disorders[3], a comprehensive guide on the most common problems that can affect both finger and toenails.

What are the treatment options for thick toenails?

No specific treatment solutions are available for thick toenails. Patients are advised to soak their nails in water and then file and trim them with a quality nail file and emery board (see procedure below). In this way, they can reduce the thickness of the affected nails. The trimming tools should be cleaned with disinfectant or alcohol before and after each use, in order to prevent the spreading of the infection (or the re-infection).

The treatment is addressed at the underlying condition, which caused the toenails to thicken in the first place. For example, if the toenails have thickened because of a fungal infection, the doctor will recommend topical solutions (medicated nail polish or cream), oral medication (antifungal drugs, such as Lamisil) or laser treatments. In more severe cases, the partial or complete removal of the nail is recommended. The removal of the nail becomes imperative in the situation that the patient suffers from intense, chronic pain. It can take up to one year for a healthy nail to grow back, so one has to be patient.

In the situation that the toenails have thickened because of trauma or aging, the doctor will recommend conservative treatments. The patient will be educated on how to properly trim the nails, in order to reduce their size; he/she will also be instructed on maintaining excellent hygiene, in order to keep the risk of infection down to a minimum. Specific medication will be administered for other underlying conditions, such as the ones mentioned above.

Natural remedies can be used to soften one’s toenails and improve the general appearance of the nails. For example, you can mix tea tree oil and olive oil in equal quantities. Then, take a cotton ball and apply the resulting mixture to the affected nail(s). The application can be repeated two times per day, for a couple of weeks or until the aspect of the nail improves. Soaking one’s feet in vinegar is also recommended; keeping your feet in vinegar & water for about half an hour can soften the nails and allow for them to be trimmed more easily.

Acidic gels are sometimes recommended for patients who have thick toenails. Such products are used to remove the excess layers built on the nail plate, being able to eliminate any infectious microorganisms at the same time. However, acidic gels should be used only at the recommendation and under the supervision of a medical professional.

Nail care step-by-step

Often times, the only solution for reducing the size of the nail plate is proper trimming. The first thing that you want to do is soak your nails in warm water, for at least ten minutes (you can add a little bit of soap as well). When the time is done, make sure that your toenails are 100% dry. The toenails can be trimmed either with a file or an emery board; what matters is that these are clean and of good quality.

Always trim the nails in a slow and gradual manner, beginning at one corner and following a straight direction to the other one. If you are patient and follow this routine, you will reduce the risk of your nails becoming split or chipped. Refrain from cutting or pushing back your cuticle in an aggressive manner, as this will only make room for harmful pathogens (increased risk of infection).

Prevention

Even though you cannot prevent the underlying conditions that can lead to thickened toenails, there are certain measures you can take to ensure your nails stay healthy. For example, you must watch your toenails carefully, identifying any changes as early as it is possible and seeking out treatment. Second, always trim your nails in a straight direction, without cutting the corners or cuticles. Use a file to trim your nails and soften the edges, thus reducing the risk of trauma.

Do not wear constrictive shoes, with very little space for the toes, as this can do a lot of damage to the toenails. Avoid socks that are made from synthetic fabrics, as these can favor fungal infections and excess moisture. Tie your shoelaces tight, in order to prevent the foot from sliding inside the shoe (and thus hurting the toenails). Avoid walking on high heels, as these can put a lot of pressure on the forefront of the foot, toenails included.

References:
[1] Diabetes and your feet. A guide to maintaining healthy feet for people with diabetes. The Society of Chiropodists and Podiatrists. Retrieved from: http://www.scpod.org/easysiteweb/getresource.axd?assetid=3512&IsMSOfficeRedirect=1&filename=/Diabetes_and_your_feet_A5_24pp.pdf
[2] Dealing with thickened mycotic toenails. Diabetes Care. American Diabetes Association. Retrieved from: http://care.diabetesjournals.org/content/11/8/687.2
[3] A Text Atlas of Nail Disorders. Techniques in investigation and diagnosis. Martin Dunitz. Retrieved from: http://www.rusmedserv.com/mycology/html/Atlas_of_Nail_Disorders.pdf


About the Author Amy Williams

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.

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