Toenails
What should I do if my nail is lifting?
A lot of conditions can affect our nails. One of these is when your nail plate (nail) separates from the nailbed. The medical name for this is onycholysis and the condition can affect both finger nails and toe nails.
Most cases of nail lifting do not lead to serious complications, but it’s worth getting your nails checked by a podiatrist, to ensure you receive the right treatment.
What is onycholysis?
Healthy toe nails are firmly attached to the nailbed and only separate at the end of your toe. However, sometimes the nail can separate from the nailbed. This is called onycholysis, and there are two types.
- Distal onycholysis — when the nail begins to separate at the edge of the nail and moves down towards the cuticle
- Proximal onycholysis — when the nail starts to lift in the cuticle area and continues up towards the end of the nail.
Symptoms of nail lifting
Symptoms that your toe nail is separating from your nailbed include:
- an abnormal border where the nail has separated which may look irregular in shape
- discolouration of your nail plate and nailbeds
- a nail that peels away from the bed
- the detached nail is white and opaque compared to its regular pinkish colour
- pits or depressions in your nail
- thickening of your nailbed where the nail has separated
- crumbling nails.
How common is nail lifting?
Nail lifting is common and can affect anyone. However, it’s more common in:
- adults
- people assigned female at birth
- people with psoriasis, lichen planus, nail fungus or tumours in the nail beds.
What causes toe nails to lift?
Toe nails can lift from the nailbed for many reasons. Factors that can contribute include:
Trauma — This may be repetitive trauma such as wearing ill-fitting shoes, injuries to the nail, aggressive pedicure treatments, or excessive exposure to moisture.
Chemical — Chemicals in nail polishes and glosses, nail polish remover and fake nails can lead to onycholysis.
Fungal infections — Fungal infections under the nail can cause toe nails to lift from their nailbeds.
Skin conditions — These include conditions such as psoriasis, lichen planus and dermatitis.
Other health conditions — Many health conditions can contribute to lifting nails including thyroid conditions and diabetes, and mineral deficiencies. You’ll need a blood test to diagnose mineral deficiencies.
Medications — Some medications such as chemotherapy drugs can interfere with normal nail development. Some antibiotics, oral retinoids, and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause toe nails to lift if they are exposed to sunlight.
Podiatrist Sydney
How to treat lifted toe nails
Once a nail has separated from the nailbed it will not reattach. Treatment aims to ensure the new nail growth remains attached to the nailbed. Left untreated, onycholysis can lead to the shortening of the nailbed.
It’s important to see a podiatrist for an assessment to make sure you receive the right treatment for your lifting nail. This will depend upon the underlying cause and may involve:
- antifungal treatments for fungal infections
- managing underlying health conditions that may be contributing to the condition
- custom-made insoles or orthotics to correct gait and walking problems that may be contributing.
Sometimes treatment will involve trimming the nail, and waiting for it to grow out normally.
How to prevent your toe nails from lifting
Taking good care of your feet is an important way to prevent your toe nails from lifting. We recommend you:
- keep your nails clean and trimmed neatly
- avoid excessive exposure to moisture and ensure you dry your feet thoroughly after exposing them to water
- avoid harsh chemicals on your toe nails
- wear well-fitting protective shoes, especially in environments where the risk of injury to your feet is high
- avoid picking at your nails
- work with your doctor to manage any health issues that may contribute to onycholysis
- ensure you follow your health practitioners advice if you’re diagnosed with a fungal infection, to
- make sure you clear up the infection
- pay attention to your feet and visit a podiatrist if you notice anything unusual.
If you have any ongoing issues with your feet, or a condition that impacts healing, visiting a podiatrist can be an important part of your healthcare.
References
Cleveland Clinic, Onycholysis, https://my.clevelandclinic.org/health/diseases/22903-onycholysis
Healthline, What to know about onycholysis (nail separation), https://www.healthline.com/health/onycholysis
DermNet, Onycholysis, https://dermnetnz.org/topics/onycholysis
Verywell Health, Onycholysis causes and treatments, https://www.verywellhealth.com/onycholysis-definition-1069359