Definition & Overview

The toenails are made up of a tough substance called keratin and protect the tips of the toes from injuries. They also provide an indication of a person’s health. Changes in the thickness and color of the nails may indicate the presence of diseases and other health conditions, such as kidney and heart problems.

The nails grow at an average rate of 1.6 mm per month and the rate of growth depends on a number of factors, such as the person’s age, health, and activity level, as well as the time of year. The continuous growth of toenails ensures that the tips are protected with a new layer of keratin at all times.

The continuous growth of the toenails also helps in pushing dirt that may have formed at the tips or the sides. Unfortunately, like any other part of the body, toenails are susceptible to diseases that reduce their strength and prevent them effectively performing their task.

Nail problems are common. In fact, statistics shows that 10% of dermatological problems involve the nails. Anybody of any age can experience these types of problems, but studies show that the frequency of the problems increases as a person ages.

Nail problems are rarely life threatening, especially if the problem is treated while in its early stages. However, if left untreated, the problem can spread to other parts of the body and cause serious damage. For example, toenails are highly susceptible to fungal infections. These infections can be treated, but if they aren’t, the infection can spread and weaken the body’s immune system. A weakened immune system leaves the body more susceptible to other diseases.

Cause of Condition

Almost half of all nail problems are caused by fungus. When the feet are confined in a warm and moist environment, the fungus can spread and cause an infection.

The remaining half of nail problems are bacteria related, or caused by injuries, improper nail care or a direct result of other health conditions, such as diabetes and poor blood circulation.

One problem that rarely occurs is melanoma, a deadly skin cancer that can grow underneath the toenails. If left untreated, the cancer can spread throughout the body and become a life-threatening condition.

Key Symptoms

Most nail problems are easy to spot. An injury to the toenails will usually create a crack in the nail, create a bruise in the nail bed, lift the nail plate, or result in the total loss of the nail.

If the problem is caused by a fungal infection, some of the most common symptoms are discoloration and the crumbling of the nail plate, flaking of the nail surface, thickening of the nail, lifting of the nail, or a smelly discharge.

A common problem is an ingrown toenail. This happens when the carved edges of the nail dig deeper into the skin. The condition is painful, especially when wearing closed footwear.

Who to See & Types of Treatment Available

Podiatric physicians handle the diagnosis as well as the medical and surgical treatment of disorders that affect the lower extremity including toenail problems. If the condition is due to a fungal infection, topical or oral antifungal medication will be prescribed. Any debris stuck underneath the nail bed as well as the diseased portion of the nail will also be removed. In some cases, a toenail removal procedure will be performed through a minor surgery or laser treatment.


  • Heidelbaugh JJ, Lee H. Management of the ingrown toenail. Am Fam Physician. 2009;79(4):303-8.

  • Ishikawa SN. Disorders of nails and skin. In: Canale ST, Beaty JH, eds. Campbell’s Operative Orthopaedics. Philadelphia, Pa.: Elsevier Mosby; 2012:chap 87.

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