How to manage a detached toenail
Detached toenails are usually safe to remove, and they will typically grow back within a year and a half.
A detached toenail can result from an injury or infection. Fungal infections or injuries may require additional medical attention to help ensure the toenail grows back properly.
In this article, we discuss what to do when a toenail is falling off. We also look at what causes a detached toenail and when to see a doctor.
What to do when a toenail is falling off
A toenail should grow back within 18 months.
When the toenail begins to fall off, a person may be advised to seek medical attention.
However, in the first instance, they may start treatment on the toenail by:
- using a file to remove rough edges
- cleaning the nail bed
- covering the area with a bandage
- carefully clipping partially attached nails
- avoiding the removal of any remaining nail
If the underlying cause is not treated, it can prevent the nail from growing back properly, or at all. An infection may require medication.
There are several common causes of a nail falling off. These include fungal infections, injuries, and psoriasis.
There are some less common causes, such as medication side effects and other illnesses, which do not affect many people.
Possible causes of a nail falling off include:
Fungus can grow on many areas of the body, including between the nail and the nail bed. When this occurs, a person runs the risk of the toenail falling off.
However, there are some signs a person can look out for before a nail a detaches. The signs of fungal infection include:
- white or yellowish discoloration of the nail
- a foul smell
- thicker toenails
- unusual toenail shape
- brittle or easily broken nails
Fungal infections can develop for many reasons and are more likely to occur when the skin or nail is broken. Key causes and risk factors include:
- cracked nails
- athlete's foot
Treating fungal infections is often tricky. It may require topical creams, oral antifungal medications, or sometimes a combination of the two.
In extreme cases, a person may require surgery to remove the nail and stop it from growing back.
Preventing toenail fungus may be easier than treating the infection. A person can prevent toenail fungus by:
- keeping the feet dry
- keeping the nails trimmed
- changing socks frequently
- disinfecting nail clippers after use
- wearing shoes in damp community areas, such as gym locker rooms
Ballet dancers may damage toenails from wearing ballet pointe shoes.
Injuries are a common cause of a toenail falling off. Even minor injuries can have this impact. Typical injuries may include:
- a bike or car accident
- dropping a heavy object on the toe
- contact sports
- ballet or other demanding forms of dance
- stubbing the toe on a hard surface
When injured, the toenail will often appear black or purple as blood collects under the nail, which is called subungual hematoma. The blood puts pressure on the nail, which may fall off after several weeks.
When the hematoma covers more than a small portion of the nail, or there is intense pain or throbbing, a person should seek medical attention. A doctor may be able to relieve the pressure by creating a small hole with a needle, which allows the blood to drain.
In many cases, a person can treat the injury at home. Common treatment methods include:
- elevating the foot
- soaking the area in cool water
- applying fresh bandages frequently
- taking anti-inflammatories, such as ibuprofen
- cleaning the area with antibiotic ointments
- clipping away jagged edges of the nail
Depending on which toe is affected, and how much of the nail is damaged, it can take up to 18 months for a toenail to grow back completely.
It is important to wear well-fitting shoes and socks and keep the nail well-trimmed to prevent further injury.
Psoriasis is a common autoimmune disorder that causes scaly, red patches to appear on a person's skin. This condition causes the body to overproduce skin cells that buildup in patches.
Psoriasis typically appears on the skin, but up to 55 percent of people with this condition also experience it on their finger or toenails.
A person who does not have psoriasis on their skin is unlikely to develop nail psoriasis. Only 5 percent of people without psoriasis on their skin will get nail psoriasis.
When psoriasis appears under the nail, it is often mild and causes minimal issues. However, the buildup of skin cells can act in the same way as blood forming under an injured nail — eventually, the pressure can cause the nail to fall off.
Symptoms of psoriasis under the toenail include:
- yellow or brown coloration
- thick nails
- abnormal nail shape
- chalky buildup under the nail
- pitting of the nail
Many of the symptoms of psoriasis and fungal infections are similar. A person with psoriasis should speak to his or her doctor to rule out a fungal infection.
A person can start to treat psoriasis by soaking the nail in warm water. A doctor will likely prescribe additional medicated creams to help alleviate the symptoms. Phototherapy (light therapy) may also be an option.
When to remove the toenail
If only part of a toenail has fallen off, it is essential to leave the remaining part of the nail in place.
In this case, instead of removing it, a person should trim or file any jagged or uneven edges to smooth it out. This will help prevent further injury or the nail catching on socks or footwear.
Any nail that has not completely come away from the nail bed or is still attached to another bit of nail should be clipped off. Once clipped, the remaining nail should be smoothed out with a file.
Dressing the damaged nail with a bandage will help protect the injury and keep the area clean.
If a person removes a nail, they are at greater risk of damaging the skin of the nail bed and of developing an infection. Signs of infection can include:
When to see a doctor
Fungal infections that do not resolve at home should be seen by a doctor to get appropriate treatment.
A person should see their doctor if they suspect an infection in or around the nail, or if they have an injury that is causing concern.
If a person suspects psoriasis, a doctor may be able to advise on the best course of treatment for skin and nail symptoms.
While a toenail falling off is usually not a major medical concern, it can be painful and annoying.
In some cases, a damaged or detaching toenail may become infected, or it may be a sign of a more serious medical condition.
A person can take steps at home to help ensure that the nail bed is kept clean and protected. If a person suspects an infection, medical attention may be appropriate.