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My toenail is disintegrating
May 29, 2011 1:01 PM   Subscribe

About a month ago, I noticed a problem with my toenail. It was discolored, and my toe hurt. The problem went away, and I didn't worry about it. But now my strange things are going on with the toenail. Should I be alarmed? Should I tell my doctor? Pictures inside!

So a month ago, I woke up in the middle of the night with fairly bad pain in my big toe. I also noticed that the little half-moon at the base of my toe was discolored. Here's a (bad, sorry) photo. Google suggested that it might be a subungual hemotoma, which would make sense, because I'd been jogging more than usual. It also felt like it might be an ingrown toenail. I resolved to go to the doctor if it didn't get better in a few days, but it did, and I stopped worrying about it. Two weeks later, I polished my toenails, and I didn't think about it again.

So today I took off my toenail polish, and my toe is... funny. It looks like someone took a bite out of the bottom of my toenail Here's a (better, kind of gross) picture. The silver stuff on my other toe is the silver toenail polish I'd been wearing, so the issue is only with my big toe. I'm pretty sure that what's below the disintegrated nail is a new nail. At least, it doesn't hurt at all to poke it. My toe feels fine.

Question number 1: is this something I should be concerned about? Question number 2: if so, should I go to urgent care today or call my doctor on Tuesday? (I have excellent health insurance which will pay for either an urgent care visit or a doctor's appointment. Money isn't an issue.) Question number 3: if it's not something I need to be concerned about, is it ok to put toenail polish on the nail?

Probably not-relevant medical detail: not long before the first toe issue happened, I started taking Nifedical for Raynaud's syndrome.

Thanks, metafilter! Sorry about the gross toe pictures!
posted by craichead to Health & Fitness (19 answers total) 2 users marked this as a favorite
 
Looks like several of my toes a few weeks after completing a marathon. The nailbed was damaged by the pressure from my shoes during the extra long hours of training (I walked so was doing many many hours at the end there), then the new toenail grew out under the old broken one. I think I lost about four nails and nine out of ten went black, which was kind of oddly impressive. But they all grew out just fine.

But damage to your nail or nailbed can make it easier for a fungal infection to set in, plus it could be something else entirely. So, given money isn't a problem, I'd get it checked out and also leave the nail polish alone for the time being. If it's not hurting and nothing else weird is happening it's probably not an emergency, but sooner rather than later is still good for getting it checked.
posted by shelleycat at 1:16 PM on May 29, 2011


If it were me, I might see a doctor about it, but not urgently. I wouldn't go to urgent care and I wouldn't call the doctor out of hours. I live in the UK and get my medical care free at the point of access, in case that's relevant.

Anecdote: after a long walk a few years ago, wearing boots that were slightly too small, one of my big toenails went mostly black, and then one day it fell off in the bath. There was a new nail underneath, and it grew in, and everything was fine. I didn't see a doctor then.
posted by altolinguistic at 1:22 PM on May 29, 2011


Fungal infection.
posted by orthogonality at 1:23 PM on May 29, 2011 [3 favorites]


My guess is nail fungus. I've seen similar-looking toenails on befungused friends and relatives. Here's a somewhat gross picture of nail fungus progression. I'd see a doctor as soon as it's convenient for you.
posted by phunniemee at 1:25 PM on May 29, 2011 [1 favorite]


The same thing happened to me after a way-too-long walk a year and a half ago. I was also on Nifedical. Nifedical can cause or worsen peripheral edema (swelling), so I wouldn't be surprised if it made it easier for jogging or shoe pressure to damage your nailbed. Eventually the new nail should grow out and the old one will fall off.
posted by WasabiFlux at 1:25 PM on May 29, 2011 [1 favorite]


If you're not in pain and not bleeding and there's nothing ontoward going on it's probably not an emergency...by all means get it looked at if you're worried but not sure I could be asked to bother with emergency care.

I've had the top layer of a part of one of my toenails come off once and I can't remember what caused it, but it looked a lot like yours does. As it wasn't painful I just kept an eye on it whenever I did my nails and it just grew out. I always paint my nails and painted over it. Beware that you are missing a layer of physical protection in that spot as the nail grows out which will be months.
posted by koahiatamadl at 1:26 PM on May 29, 2011 [1 favorite]


Nthing fungus. You can go to the dermatologist and get a prescription for Lamisil but from what I remember you had to get blood work done fairly frequently and it wasn't really worth it to me.
posted by tatiana wishbone at 1:49 PM on May 29, 2011


I know this is gross, but I have never had a fungal infection that I could not kill with my own urine. I'm serious. Pee on your toes.
posted by Mr. Yuck at 2:29 PM on May 29, 2011


It's not fungus. It is just a damaged nail bed as shelleycat said, probably caused by jamming your toe while running. The damage occurred just under the cuticle and is just now becoming visible a couple weeks later as the new nail grows out. You will have a little groove between the new and old nail which will very gradually move to the tip of your toe over the next several weeks as the nail grows outward. Eventually the groove will be at the tip and you just trim it off. Nothing to get excited about. It's about as boring as watching your nails grow.
posted by JackFlash at 2:33 PM on May 29, 2011 [4 favorites]


I agree it looks like your toenail is falling off as a new one grows in under it. This is pretty common, actually. It could be from the jogging, or you could have stubbed it and forgotten, it doesn't take much if it happens to be at exactly the right (wrong) angle. As long as the toenail underneath seems OK I wouldn't fuss over it, just skip the nail polish so you can keep an eye on it.
posted by anaelith at 2:49 PM on May 29, 2011


I run and play soccer and generally have at least one funky toenail going on at a time- usually they turn blue and thicken, then eventually fall off. Sexy, I know. It's due to the pressure from athletic shoes and not an infection, and I'm guessing yours is the same. Definitely not urgent. It it hurts at all or starts looking like a fungal infection (which it doesn't in your pictures), then yes, go see a doctor. I don't think nail polish will harm it and it will certainly look better!
posted by emd3737 at 2:52 PM on May 29, 2011


I agree with those who say you damaged the nail bed and you are seeing the damaged nail grow out slowly. Nail fungus does not cause holes in the nail but makes them yellow and thickened; we have dealt with both conditions in my family. As mentioned above, injury can make your nails prone to infection, so it wouldn't hurt to keep them extra clean for a while.

I have not heard about urine for nail fungus, but since it doesn't do any good for athletes foot (which is much easier to cure) I doubt it would make a difference. But it probably wouldn't hurt to try it.
posted by TedW at 3:26 PM on May 29, 2011


Nail fungus can cause the nail to separate from the bed; that happened to one of my fingernails as a teen. It eventually grew out but it still looks a bit different now, 25+ years later. That's not too unusual - you can even get over the counter stuff marketed to deal with "keratin debris" from past fungal infections. I bought some a year or so ago and have never gotten around to using it.

Trauma can do that too, as I can prove with my left thumb where I smacked it with a hammer a little over a month ago. A section in the center separated from the nail bed because of the blood and it probably could have completely come loose if I hadn't pierced it to let the pressure out. Now I have a big hole in the middle of the nail that looks significantly like yours does there in the missing part.

You can see someone if you want but the best they're going to do is write you a scrip for something for nail fungus and tell you to keep it clean and be careful of injuring yourself in that tender spot.

You can just as easily use some white vinegar - put a few drops on in the morning and evening and call it done. I seem to recall some studies showed it about as effective as other topicals but I can't find them effectively. You could use urine too I suppose - I recall stories about workers avoiding infection in their work-injured hands 100+ years ago using the same method - but personally I'd rather not pee on myself unnecessarily.
posted by phearlez at 4:19 PM on May 29, 2011


I don't think it's a fungus either (as JackFlash, shelleycat, and TedW said), for the reasons TedW mentioned, but I do think your Nifedical played a role in causing the problem.

Raynaud's syndrome involves severe impairment of peripheral circulation, and this can starve the toenails of the nutrients they need to grow normally, making them thinner and weaker than they would ordinarily be.

Nifedical increases peripheral circulation, and I think that's made your nail much thicker and stronger since you started taking it. When you jogged, the stresses on your toenail could have caused a lot of flexing at the borderline between the old and new growth which may have made it more visible and painful, and it seems likely to me that's the line we see in the second photograph.

The half moon at the base of nails is actually a gas-filled space between the nail and underlying tissue. What you refer to as a discoloration looks to me merely like an absence of that space, and may have been produced by vigorous new nail growth forcing a downward pointing kink in the tail end of the weaker part of the nail.
posted by jamjam at 4:29 PM on May 29, 2011


yup, nthing damaged nailbed from running. over about 8 weeks the old one will get pushed out. keep it trimmed, you can put nailpolish on it to camouflage.

for prevention in future, a) keep toenails very short and squared b) make sure you have enough room in the toebox of your running shoes, and they're laced properly to minimise your foot sliding around and c) always increase running mileage gradually.
posted by wayward vagabond at 8:34 PM on May 29, 2011


I had nail fungus on my thumb, but at one point I was able to sort of peel/tear it so that (since the infected nail had long separated from the nail bed) the bottom area was removed but the top was intact (very similar to your nail). The underneath part, the part that you suspect is new nail, actually grew in clear and fungus-free, even though my entire nail had been infected before and (at that point) I wasn't on any sort of treatment or anything.

I suggest just letting it grow in - for me, it grew in fine and better than my previous nail. If I were you, I wouldn't even bother with the doctor - just be careful and wear shower shoes if you shower in a public place (swimming pool, etc - that's probably where I caught it) since you may be more prone to infection. A topical fungus treatment might work as a preventative measure as well, even though they don't really work on existing infections.

I don't think it's fungus. It doesn't look like fungus (at least my fungus) and that's not really how it started on any of my toes (and the one finger). It usually starts under the corner of a nail with thickened, yellow nail and grows from there.
posted by R a c h e l at 9:52 PM on May 29, 2011


IANAD - I had something similar when I bruised my toe. Dark stain under the toe, then I lost some of the nail, which grew back out.
posted by Not Supplied at 11:20 PM on May 29, 2011


I lost my entire toenail once about a week after a long and difficult hike. It looked ok but made a weird hollow sound when I trimmed it. Turns out it had detached from the nail bed completely and I just pulled it off, no pain or anything. It grew back fine. But it wouldn't hurt to see a doctor.
posted by chairface at 11:52 AM on May 30, 2011


Thanks everyone! I know we're not supposed to ask medical questions on metafilter, but this has been super helpful.

So here's what I've decided. It seems like this is not an emergency, so no urgent care. I am going to call my doctor tomorrow, even though it sounds like this probably isn't a big deal, just to be on the safe side. (That progression of nail fungus link made me want to stop the progress of any nail fungus I might have. Also, I have some very minor chronic health problems, and I probably need to get out of the habit of ignoring symptoms.) Assuming that it is an injury to the nail bed and no big deal, I will go to a decent running store and make sure that I'm wearing the right running shoes.
posted by craichead at 12:19 PM on May 30, 2011


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