Help! I Lost a Toenail

Have you ever lost a toenail?  Wondered why it happened and what to do next?  I’m here with some answers today.

The fancy name for a toenail falling off is onychoptosis.  There are three main causes- infection, trauma and illness.  

Infection – Fungus is the most common type of infection that occurs in the nail.  Bacteria can be a problem as well.  Less commonly, hand foot and mouth and other viral disorders can cause loss of toenails.

Trauma– This is VERY common.  Dropping something on the toenail or “stubbing” a toe can cause damage to the nail matrix or a bruise/hematoma under the nail.  This is most commonly seen on the great toe or the second toe if it is longer than the great toe.  This is commonly seen in athletes and hikers as well, from the toe hitting inside the shoe. 

Illness– A severe illness, surgery, or change in diet can cause onychomadesis to occur.  Onychomadesis is the cessation of nail growth at the nail matrix at the base of the nail.  When this occurs, most all of the toenails or fingernails fall off at the same time after a new nail grows up underneath the old nail.

In the picture above, the patient’s second toe was longer than her great toe.  She had done a significant amount of hiking a few months before.  This likely caused enough trauma to the nail matrix to cause onychomadesis.  The size of the nail that was already growing underneath the old nail is consistent with an event a few months ago because it can take 9-12 months to grow a full new toenail.

Now what?!  Now that the nail bed (the soft part under the nail) is exposed, the main goal is to protect the new nail from further trauma and infection.

Protect the nail bed with something like Zen Toes https://www.amazon.com/ZenToes-Pack-Gel-Toe-Protector/dp/B01N0C1QIA?th=1 which is a silicone gel toe cover to protect the toe and nail bed from further injury.

Apply Lamisil antifungal cream to the nail bed a few times a week if there was no prior nail fungus and every day if there was or is active nail fungus. 

Do Vinegar soaks if there is any infection on the feet or toenails.  Vinegar is a great astringent and something I often recommend to my patients.  For a foot basin, use about ¼ cup of vinegar with water (any temp) enough to cover the feet.  Soak 15 minutes once a day if possible.

So, if you do lose a toenail, don’t panic.  It will eventually grow back!

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