Nail Problems

D4S_1790_LargeYour feet – indicators of health

Because they are so far away from our heart, our feet are often the first part of the
body to show something is wrong with the way blood circulates in our body.

The condition of our toenails can signal the presence or beginning of several diseases.
For example, toenails that are hollow instead of being rounded can indicate iron
deficiency or anemia (a shortage of red blood cells). Increase nail thickness, or bumps on
the nail, can be manifestations of psoriasis, a skin disease.

Your podiatrist will always check the condition of your toenails, and can provide a range
of treatments for all your toenail problems.

Our toenails

The major parts of the toenail are: the nail itself (nail plate); the matrix, from where the
nail grows; the lunula, the white, moon-shaped area at the base of the nail; the nail bed,
the tissue on which the nail lies; and the sulcus, the groove at the side in which the nail

Toenails grow constantly. Healthy nails are pink, free of dirt and impairment, and grow
into the grooves normally. It takes up to 12 months to replace the toenail of your big

Who gets nail problems?

Toenails of people of all ages can undergo a range of changes, some of which are relatively common. They can become thick, brittle, curved, discoloured, infected, clubbed, bumpy and grooved. In some cases, the nail falls off and a new one grows. As we grow older, we are more likely to develop toenail problems.

What causes nail problems?

Toenail problems may be caused by warts, tumours under the nail, trauma, infection, or
poor circulation. Major toenail problems can be caused by incorrectly fitting shoes, which
press too tightly on the toenails. Injury, such as bruising under the nail and infection can
cause permanent nail deformity.

Common conditions and treatment

Ingrown toenails are the most common toenail problem. They may be caused by
improperly trimmed toenails, very curved edges of nails, shoe pressure or repeated trauma
to the feet from normal activities. They may also be inherited. Frequently the pain is due
to a corn or callus in the groove (sulcus) of the toenail.

Most cases will require conservative treatment, while others may need surgical
correction which can be conducted in your podiatrist’s rooms using a local anaesthetic.

Thickened nails is a common condition. Usually the result of injury to the nail bed, such
as dropping something heavy on your toes, or fungal infection. They can be easily and
painlessly thinned down by a podiatrist.

Fungal infections are among the most troublesome of nail conditions to treat. They are
often characterized by thickening, discoloration and separation of the front of the nail
from the nail bed. In some cases, the nail crumbles. These infections tend to stay in the
nail if they are not treated, and can infect the nail bed and matrix

There are a range of anti-fungal medications available for treatment in addition to laser treatment. Your podiatrist can
assist with trimming and care of out-of-shape nails.

Other infections cause inflammation of the matrix (onychia) and inflammation of the
tissue adjacent to the nail (paronychia). In people with lowered immunity, this may lead to
serious complications, including more widespread infection extending up the leg. Your
podiatrist can detect such infections early and form a suitable treatment plan.

Trauma to the nails may lead to permanent nail deformity. This can be cared for by
regular, non-painful podiatric treatment, involving filing and possibly the use of a special

Older people

Older people with poor circulation are prone to fragile or brittle nails

Many older people do not have the strength, flexibility, or eyesight to trim their nails,
especially if the nails are deformed. They should seek podiatric care for these services,
and advice regarding safe self care.

Warning signs

Any sudden changes in colour or shape of the nail, sign of infection, development of a
freckly under the nail, or pain should be discussed with your podiatrist. Your podiatrist
can diagnose the problem and then advise an appropriate treatment.

Taking care of your nails

  • Trim toenails straight across to a length just below the end of the toe. Do not round
    off the corners – this can cause ingrown toenails
  • Use a strong pair of nail clippers
  • After clipping, smooth nails with a file or emery board, using downward strokes
  • Wear only properly fitted shoes, not short or narrow ones
  • Wash feet regularly, especially between the toes, and dry thoroughly
  • Wear socks or stockings that are not too restrictive

Text reproduced with permission from the Australasian Podiatry Council