Nail Deformities

What is it?

Your nails are made of hard skin cells called keratin. Their function is to protect the ends of the fingers and toes but they are also useful for scratching and picking things up. The nails on your fingers take about 3-6 months to fully grow whereas the nails on your toes can take 8-12 months. This can vary greatly from person to person depending on general health, circulation and age. There are many deformities that can affect the nails, some are easier to resolve than others and some are permanent.

Common nail deformities

Thick nails

  • Usually appear darker than normal and can occasionally be painful especially when cutting.

  • Caused by trauma sustained over a long period of time – such as wearing tight fitting footwear or playing sport – or obtained in one traumatic incident. They may also be inherited.

  • Unfortunately, this is a permanent deformity but can be made more comfortable and less unsightly by regular filing or drilling of the nail by a podiatrist. Picking or trying to clear the skin underneath will not help; in fact, it can make the problem worse

Horizontal lines or grooves

  • Caused by a temporary cessation of nail growth. This may be due to malnutrition or an illness.

  • Treatment for this condition is not necessary, as the lines will grow out with the nail.

Black spots

  • This is often bleeding under the nail plate caused by trauma. Depending on the severity of the trauma, it is not unusual for the entire nail to become loose and fall off. If the nail is loose, it is best that it is removed completely to allow the new nail to grow through without any resistance. If left on, the old nail can cause pain and deform the new nail growth.

  • Initial treatment can include applying an ice pack to reduce the bleeding. Your podiatrist can make a small hole in the nail plate to allow the blood to leak out which will reduce pressure and save the nail from coming off.

  • Rarely, a black spot may be a melanoma under the nail.

Curved or involuted nail

  • These can vary from slightly curled at one or both edges, to the nail curling in completely to form a tube. Caused by pressure from footwear or neighbouring toes or by growth of skin underneath. They may also be an inherited.

  • Due to the shape, these nails can cause pain and discomfort as the skin is pinched or pressed along the edge of the nail.

  • Treatment can include either leaving the involuted side to grow out to the end of the toe or cut down the side at an angle to remove the curled edge. Your podiatrist will be able to do this very effectively and may pack foam under the remaining corner to encourage the nail to flatten out. If the pain cannot be managed with regular treatment, a simple procedure may be required to permanently remove the curled side

White patches

  • These can be caused by trauma or a fungal infection.

  • Where the nail becomes separated from the nail bed and appears as a white patch, this is known as Onycholysis. Onycholysis is caused by trauma - from shoes or a neighbouring toe pressing against the side of the nail - thyroid disorders, some skin conditions or may be idiopathic (without cause).

  • Treatment for onycholysis is dependent on the cause.