Treating Trauma to the Toenails

Trauma to a toenail can be particularly painful, especially if it is an acute incident. This trauma can lead to an initial acute problem or chronic long-term problem with the nail thickness and shape. The acute trauma such as from an accident or badly stubbing the toe is obvious when it happens. What is not so obvious is the toenail changes that happen from trauma, but no problems are noticed until months later when the toenail becomes thicker and deformed.

The most common reason for a deformity of a toenail is trauma. That trauma could come from a one-off event like dropping a brick on the toe or it could come from the repeated trauma of wearing shoes that are too tight and the constant pressure on the nail from that. It can also come from loosing the toenail from the foot sliding around in the shoe, for example in tennis player. This trauma could affect one or multiple or all of the toenails. The nail plate grows thicker because of damage to the nail matrix or growing area of the nail. As well as getting thicker that nail plate can also be distorted or deformed. If the nail plate is just thickened, this gets called onychauxis. If the nail plate is deformed as well as thick, then this gets call onychogryphosis. If after the nail is traumatised and the nail matrix area is not damaged, the nail may grow back a normal thickness, but may have a ridge of thickened area of nail that grows out as the nail grows.

To treat the acute toenail trauma, there is going to need to be some medication to help with pain relief. Any parts of the nail that can be removed without any problems should be removed. The nails and the surrounding area need to be thoroughly cleaned with an antiseptic. Sometime what is left of the nail is removed under a local anaesthetic. It is important that the toenail is protected with a wound dressing and if there is an open wound there, precautions need to be taken to prevent any infection developing. The management of the onychauxis and onychogryphosis problems require a long-term plan and not just the one-off management of the acute trauma. Adequate management of the acute episode will lower the risk of these thicker toenail types of problems. The only way to manage the onychauxis type problems is to keep the name cut short and using a file to reduce the thickness. That can take a lot of effort, especially if the toenail is deformed as well. It is usually a good idea to see a podiatrist to get the nails cut and reduced down. They will typically use a high-speed drill to reduce the thickness. Unfortunately, as the damage is in the growing area of the nail it will only thicken up again meaning that onychauxis is an ongoing problem. If they do prove to be too difficult to manage, then permanent surgical removal of the toenail is an option.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.