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September 3, 2021
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Many people know that nails are made up of keratin – the same stuff found in hair. Still, not many people know exactly how nails grow. Did you know that toenails develop before birth, with the toenails becoming fully formed by month 8 of development!
The hard, flat, pink surface of the nail is called a nail plate, it’s what most people think of when they think of nails. It protects the nail matrix, which is the underlying tissue containing blood vessels, lymph, and nerves. Additionally, the nail plate’s function is to assist in fine motions of the toes, such as pressing and pushing.
The matrix, where the nail grows from, extends downwards to the base of the nail under the nail fold. The nail fold is the skin near the cuticle where the nail begins. The matrix is where nail cells are produced, as new nail cells are formed, old nail cells are pushed forward. Flattening and hardening, until several layers are compressed to form the translucent nail plate.
The nail plate pushes past the nail bed to form the free edge that does not meet any surface and is the part that can be painlessly cut. The nail bed is the skin that is under the nail plate, it is what gives nails their pink color due to the rich network of blood vessels visible under the translucent nail plate.
Ever noticed the white half-moon shape on your nail? That’s the lunula. It’s the only visible portion of the matrix. The edges of the sides of the nail end in grooves called the sulcus, which then lead to the skin on either side – the medial and lateral nail folds.
Toenails grow at a rate of approximately 1.5mm per month! A number of factors contribute to this rate. Age, hormone balance, frequency of trimming, current health status, blood circulation throughout the body, and conditions such as onychomycosis (fungal nail infection) affect the rate at which the nail is able to grow, either slowing it or speeding it up. Nails are therefore an excellent indicator of an individual’s overall health.
Nails usually grow unremarkably, and some individuals are lucky enough to never experience any discomfort with regards to their toenails. Most people, unfortunately, have experienced a painful toenail at least once in their lifetime. This can be in the form of an ingrown toenail (onychocryptosis), or nails that become involuted.
Ingrown toenails can range from uncomfortable to extremely painful. This condition occurs when one or both edges of the nail grow into the sulcus of the nail and press into the nail fold instead of growing straight out to the free edge. This is most common on the big toe.
The two most common causes of ingrown toenails are incorrect nail cutting and ill fitting footwear. Other causes are fungal nail infections (onychomycosis), repetitive trauma such as in running or kicking and poor foot posture.
Ingrown toenails begin with discomfort and the toe appearing red and swollen but can quickly become more painful. If left untreated, they may become infected, with pus often oozing from the affected sulcus. Many individuals attempt to remove the nail themselves, only to cause an infection and unknowingly leave behind a small spike of nail that continues to ingrow and cause pain. Self-treatment is discouraged since it makes it worse.
Involuted toenails occur when the nail plate begins to curve enough to pinch the nail bed, causing pain. This is a chronic issue and can affect quality of life. It is very difficult to trim these toenails at home due to their shape. They may also become thicker, making it even more difficult to cut. These toenails can become ingrown and infected, leading to even more pain. Ill-fitting footwear, genetic predisposition, developmental anomalies, or the presence of a growth on the bone of the toe lying under the nail can cause a nail to become involuted.
Treatment of ingrown and involuted toenails depends on the individual and may consist of conservative management or surgical intervention, or sometimes both. Treatment options depend on health status and lifestyle. If conservative management of the nail is not successful then a minor surgical procedure with permanent results can be performed. Correct nail cutting techniques, nail care and maintenance at home, as well as education about fitting shoes correctly should be included in the selected treatment plan, whether conservative or surgical.
Many people do not pay attention to their toenails, until something goes wrong. Nail care should be a regular part of daily life. The best thing you can do for your toenails is to avoid tight socks and tight or narrow or shallow shoes. Wash your toenails by hand daily when having a shower. If you already have toenail problems then visit us before it gets worse.
Podiatrist 20 years of clinical experience. Practiced in South Africa, Malaysia, and Singapore. Pioneered CAD/CAM custom made orthotics in S.E Asia.
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