Onycholysis – Toenail Lift Off

Written by Michelle Champlin BSc Pod., M.Ch.S., S.R., Ch., (UK)
Onycholysis is the name used to describe separation of your toenail from the pink nail bed. This happens gradually over time and is painless. Usually, it’s the big toe (hallux) that is affected, as this tends to be the longest and largest toe and most exposed to trauma.
Causes
One of the most common causes is due to repeated, minor trauma to the toenail, commonly from wearing enclosed shoes that are too small in the toe box. When walking, your toe will repeatedly tap off the top of the inside of the shoe and cause bruising and eventually the nail to start to lift off.
• We often see repeated trauma in athletes – sports such as netball, where there is a lot of stop/start forefoot motion
• Wearing work boots with steel toecaps that aren’t roomy enough for the toes
• A side effect of some medications, such as tetracycline, followed by sun exposure
• A fungal toenail infection (onychomycosis) left untreated can eventually worsen if left untreated and cause the nail to thicken and separate from the nail bed
• Underlying medical conditions, such as an overactive thyroid
• The skin condition psoriasis
• Over-pedicuring – the use of hard metal or wooden pedicure tools underneath the nail can result in progressive separation of the nail from the bed.
• Excessive moisture.
Symptoms
You may notice that the white portion of the nail increases – it will sometimes even turn green or yellow. The pink border may look irregular. The skin of the nail bed may be thickened, and nail itself may appear bruised, pitted, ridged, dented or thickened. If there is also a fungal infection co-existing, the nail may also be dry, brittle, flaky or yellowed amongst a range of fungal nail symptoms.
What to do
Visit your licensed podiatrist – we look at toenails and feet all day, every day and will be able to diagnose the nail problem accurately, as well as any underlying cause of the onycholysis and any co-existing infection or anomaly. We will advise the most appropriate treatment(s).
Treatment
Treatment advised may range from:
• Trimming the nail back to its attachment
• Complete or partial avulsion
• Addressing any underlying cause – such as investigation of and treatment for any suspected underlying cause, such as thyroid medication
• Footwear / foot care advice.
Prevention
Your Podiatrist as part of the overall diagnosis and treatment plan will identify the cause and advise on how to protect your nail from future recurrence. Your Podiatrist may advise on sports footwear and sizing, to foot and toenail care and medication. Toenails can take circa 9 months to fully regrow.
Top Tips
• Ensure all footwear, especially safety/uniform shoes and sports shoes are the right size. Sports shoes should be half a size to one size bigger, depending on your preferred shoe brand, sport etc.
• If you must wear a particular uniform shoe for work, protect toes from friction using protective in-shoe silicone gel toecaps.
• Never use, or allow a pedicurist to use, a sharp or hard instrument under your toenails.
• Don’t cut away your cuticles – their job is to stop infection causing micro-organisms and spores from entering the matrix, where your nail grows from.
• To keep underneath toenails clean and free from debris build up – use a nailbrush. Or better still, Chief Podiatrist Michelle Champlin has a secret tip: ‘Buy a cheap battery run toothbrush specifically for your toes. These will clean gently and safely underneath your nails and you can run them across the top of your nails too for lovely, clean nails. Just be careful to keep it well separated from your oral toothbrush!’
• Avoid wearing nail polish on toes except for special occasions – remove it after a day or two and never keep it on for weeks. Long term nail polish provides a perfect breeding ground for fungal nail infections, as well as staining and drying out the nail. You remove your make up every night – treat your nails with the same hygiene.
• Keep toenails trimmed short and straight across, filing to remove sharp corners.
• Never cut down the sides of your toenails.
• Try home pedicures by filing your feet with a gentle foot file every second day, keeping toenails moisturized (and polish-free) with an oil such as Vitamin E and trimmed short and straight. Moisturize your feet with a urea-based foot cream. Treat yourself to a home spa treatment with silicone moisturizing bootees that will rival any beauty salon’s treatment and are worn around the house for only half an hour in the evening.
• See your Podiatrist for routine foot care every 3-6 months, as well as if you experience any toenail issues after taking up a sport.
If you experience any pain with your toenails, or they look bruised, discoloured or like they might be lifting off from your nail bed, make an appointment with your Podiatrist. Your Podiatrist can also carry out ‘routine maintenance’ for your feet to top up your home pedicures – safe and sterile removal of callous, painless toenail correction and maintenance and spotting early any underlying infections or issues. Dubai Podiatry Centre’s UK trained and qualified Podiatrists are licensed by the DHA and able to assess, advise and treat a wide range of toenail issues including onycholysis. Contact us on +971 4 3435390.