Toenail Problems?

Toenails mean different things to different people. Some people could care less about the appearance of their toenails, while on the other hand, some people are extremely self-conscious and are severely embarrassed if the slightest discoloration or malalignment is present. Most people more or less fall in between. Whether you do or don’t care about your toenails, I am going to tell you about some things that may give you some insight about why your toenails might be discolored or shaped funny looking.
Patient come into the office all the time saying their toenails are green, yellow, black or red. People complain of long toenails, thick toenails, curly toenails, stinky toenails, ingrown toenails, toenails ripped half-way off, toenail ripped completely off. The are as many toenail disorders as are colors of the rainbow and honestly, there are too many to talk about.
My goal for this blog is to let you know of the more common things that cause toenail to be discolored or mishapen. OK, let us get started.

The most common problem I see patients complaining of is nail fungus.
There is not one particular place you get nail fungus. Sometimes the nail fungus just happens, like magic. Sometimes the nail fungus is caused by walking barefoot outside and getting soil under the nail plate. Sometimes it is caused by trauma to the nail, in which the toenail gets smashed and loosens up from the skin underneath and makes the toenail more susceptible to fungus. Whatever the cause, nail fungus is cause by 3 main types of fungus. They all have long names, but just in case you were wondering what they were, here they are: T. mentagrophytes, T. rubrum, and E. floccosum. Nail fungus can manifest in different ways. It can make toenails turn yellow, white, green, brown. The nail usually gets very thick (like a raptor’s claw) and is difficult to cut with regular nail nippers. Oftentimes, the nail nipper will break before you get the nail clipped.
How we test to see if you have nail fungus is by taking a small sample of the nail and sending it to a lab. At the lab they can run various test looking for specific findings consistent with fungus. We usually get a report back from the lab in 1-2 weeks.
Our treatment regimen at Advanced Foot and Ankle Center hits the nails from a bunch of different directions.
First, if you have no pre-existing liver conditions, then a pill called Lamisil is the best option. Lamisil is taken once daily for 12 weeks or 84 days. Prior to taking Lamisil, you have to have your liver checked by going to a lab and having your blood drawn to look at your liver enzymes. If you liver enzymes are normal, then you begin taking the Lamisil. Half-way through the treatment, the liver enzymes are checked again to make sure the Lamisil hasn’t compromised your liver. If your liver is again normal, then you may continue the 2nd half of the treatment regimen.
Secondly, we recommend a OTC antifungal nail lacquer in our office called Formula 3. Formula is painted on the nail twice daily. I believe the Formula 3 works much better than the prescription equivalent called Penlac.
Thirdly, the shoes must be treated for fungus. We have a product in our office called Mycomist. Mycomist is sprayed in the shoes to kill any fungus hiding in the shoes.
By performing this three products combo, our results have been very successful in the treatment of nail fungus.
Sometimes clinically, the nail may be green and thick and look exactly the way fungus should look, but it is not fungus.
If this happens, then the discolored and malformed nail is from one of a few things.
1. The nail may have been traumatized. I have seen smashed toenails caused by everything from a frozen turkey to cans of green beans. If the toenail is damaged and the nail matrix is damaged, the nail can grow wildly and mimic nail fungus. Oftentimes, patients do not remember traumatizing the nail until I remind them.
2. The toe bones may have a bone spur that is pushing up causing tenting of the nail and causing it grow crazy. Sometimes the bone spur has to removed in order to grow a “normal” nail.
3. In runners specifically, the toes can repetitively jam into the front of the shoe and cause toenail injuries. In patients who run miles daily or weekly, the constant trauma to the nail can cause the nail to grow deformed.
Sometimes by changes the biomechanics of the foot can rid the toenail problems.
If you have a funny looking toenail and are wanting it treated, please come see Dr. Kory Williams or Dr. Eric Silvers at Advanced Foot & Ankle Center for examination.
Have a nice day!
~Dr. Williams