Toenail Problems & Nail Care: Podiatrist Guide | DPM

>

Table of Contents

• Fungal Nails (Onychomycosis)
• Ingrown Toenails
• Toenail Trauma & Black Nails
• Nail Psoriasis
• Nail Dystrophy & Thickening
• Treatment Options
• When to See a Podiatrist
• FAQ

Your toenails can tell you a lot about your overall health — and when something is wrong with them, they are hard to ignore. Whether your nails have turned yellow and thickened, started to grow into your skin, or developed a painful bruise under them, toenail problems are among the most common and most undertreated foot complaints we see. Many patients try over-the-counter remedies for months or years before seeking care — often because they’re not sure if the problem is serious enough to see a doctor. The answer: almost always yes, it is worth getting evaluated. Here is a complete guide to the most common toenail problems, what causes them, and what can be done.

” alt=”toenail problems fungus ingrown nail treatment podiatrist Michigan” width=”1200″ height=”630″ loading=”eager” fetchpriority=”high” decoding=”async” />

Fungal Toenails (Onychomycosis)

Onychomycosis — fungal infection of the nail — affects an estimated 10% of the general population and up to 50% of adults over 70. The fungi responsible (dermatophytes, most commonly) invade the nail plate through microscopic breaks and thrive in the warm, moist environment of closed-toe shoes. Signs include yellow, white, or brown discoloration; nail thickening; crumbling or brittle nail edges; and a musty odor. Importantly, not every abnormal nail is fungal — psoriasis, trauma, and nail dystrophy can look identical. Culture or PCR testing confirms the diagnosis before prescribing oral antifungals.

Treatment options range from topical antifungal lacquers (effective in early, superficial cases) to oral terbinafine (the most effective systemic treatment, with 60–70% cure rates) to laser therapy. In our clinic, we also offer nail debridement, which improves penetration of both topical and laser treatments. A full course of oral terbinafine takes 3 months, with nail clearing taking up to 12 months as the new nail grows out.

Ingrown Toenails (Onychocryptosis)

An ingrown toenail occurs when the edge of the nail grows into the adjacent soft tissue, causing pain, redness, swelling, and sometimes infection. The great toe is most commonly affected. Causes include improper nail cutting technique (cutting too short or rounded at the corners), tight footwear, nail trauma, and nail shape (naturally curved or “pincer” nails). Mild cases can be managed at home with proper soaking and correct trimming. Recurrent or infected cases require professional treatment — partial nail avulsion (removing the offending nail border) with or without phenolization of the nail matrix to prevent regrowth provides permanent relief in over 95% of cases.

Toenail Trauma and Subungual Hematoma

A blow to the toe or repeated microtrauma from running (especially downhill) can cause bleeding beneath the nail — a subungual hematoma — which appears as a red, purple, or black discoloration. Small hematomas are painful but resolve on their own as the nail grows out. Large, painful ones can be drained with a needle or heated wire to relieve pressure immediately. Importantly, melanoma of the nail (subungual melanoma) can mimic a traumatic hematoma — any nail discoloration without a clear traumatic history, or one that doesn’t grow out with the nail, requires biopsy to rule out malignancy.

Nail Psoriasis

Nail psoriasis affects 80–90% of people with skin psoriasis and up to 5% of the general population without skin involvement. Features include pitting (tiny depressions on the nail surface), oil drop discoloration (yellowish-red spot under the nail), nail thickening (subungual hyperkeratosis), onycholysis (nail separating from the nail bed), and crumbling. Because nail psoriasis looks very similar to fungal infection, a nail culture or biopsy is essential before prescribing antifungals for what might actually be psoriasis. Systemic biologics and topical steroids are the primary treatments.

Nail Dystrophy and Thickening

Nails that become thickened, ridged, or misshapen without a clear infective cause are classified broadly as nail dystrophy. Contributing factors include chronic pressure from tight footwear (onychogryphosis — the “ram’s horn nail”), age-related nail changes, vascular insufficiency (nails thicken with reduced blood flow), and systemic conditions like diabetes. Regular professional nail debridement — trimming and thinning the nail — is the primary management. Proper footwear fitting prevents further nail damage.

---

Frequently Asked Questions

How do I know if my toenail is fungal or not?

Yellow, thickened, or crumbling nails are classic signs of onychomycosis, but the same appearance can come from psoriasis, trauma, and chronic pressure. The only way to confirm fungal infection is with a nail culture or PAS-stained nail clipping sent to a laboratory. This matters because oral antifungals have side effects and take months — treating the wrong condition wastes time and risks unnecessary drug exposure.

Does nail fungus go away on its own?

Rarely. Onychomycosis almost never self-resolves. Without treatment, it typically spreads to adjacent nails and worsens over time. Early treatment — when only part of the nail is involved — leads to much higher cure rates than waiting until the entire nail is affected.

Is laser treatment effective for toenail fungus?

Laser therapy can reduce fungal load and improve nail appearance, but its cure rates in randomized controlled trials are lower than oral terbinafine alone. In our clinic, we often use laser as an adjunct to topical antifungals for patients who cannot tolerate or prefer to avoid oral medications. Results vary, and multiple sessions are typically needed.

The Bottom Line

Toenail problems are more than cosmetic — they can cause pain, affect gait, and in patients with diabetes or vascular disease, lead to serious infection. Getting an accurate diagnosis before treatment is essential, especially for distinguishing fungal nail from psoriasis or trauma. Whether you need a nail procedure, prescription treatment, or simple nail maintenance, our team at Balance Foot & Ankle is here to help you have healthy, pain-free nails.

Sources

• Lipner SR, Scher RK. “Onychomycosis: treatment and prevention of recurrence.” JAAD, 2024.
• Singal A, Khanna D. “Onychomycosis: Diagnosis and management.” Indian J Dermatol, 2023.
• American Academy of Dermatology. Nail Disorder Guidelines, 2025.

Related: what white spots or white toenails mean and when they signal a problem.