Where do I go with these toenails?

April 24, 2024 8:23 PM

My toenails have been problematic for a few years. It started with just one of them turning white and becoming thicker. This then happened to first all toes on my right foot, and more recently the left. Right now, two nails on my left foot look healthy. The other three are thicker than they should be, soft and dull instead of shiny, and there's a small blue stripe under the big toenail. On my right foot, two nails are thickened and slightly discolored (beige). The big toenail appears loose. It's firmly attached at the base, but not so much at the top.

First off: I know this sounds like foot fungus. My dermatologist insists it's not.

None of this is painful, really, though I miss the protection of sturdy nails. I went to see a dermatologist and was told (after lab work) that I don't have any sort of fungus. That's nice. But I really want to fix the issue, and the doctor had no input on this. She said that nails just become less sturdy with age, but...I'm in my thirties, not eighty, and I don't see this happening to any of my friends.

I think I take pretty good care of my feet. They spend most of their time in cotton socks, no shoes. When I do wear shoes, they're breathable and a good fit. I change my socks twice a day. I moisturize my feet semi-regularly, keep my nails short enough, and take baths (with my feet) at regular intervals. My nails were always healthy before this started happening, and my fingernails are still perfectly normal. I haven't changed my diet over the last years, except perhaps eating slightly more processed foods.

I'm not opposed to seeing another doctor, but this is an embarrassing problem to have, and I want to be sure I'm going straight to the right person. If dermatology is not the field I want, which is it?

PS: I know I should have dealt with this sooner. The pandemic made it difficult, but also, I'm being avoidant because it's just sort of gross. I don't want to look at my toes, let alone show anyone else. So if I can get some encouragement to tackle this with minimal judgment, that would be ideal.

posted by toucan to Health & Fitness (13 answers total)

I would get a second opinion from a different dermatologist or even a podiatrist. I had this for over a decade, it was toenail fungus, and lamisil cleared it right up in six weeks! This was ages ago, and there's a better drug available now--terbinafine.

One other thing that can cause similar symptoms is psoriasis, but it would be odd to only have it on your toenails.
posted by Violet Hour at 8:37 PM on April 24 [5 favorites]

I'm not opposed to seeing another doctor, but this is an embarrassing problem to have

I'm sure you find this embarrassing, but you have to remember that doctors see this stuff all the time. Your toes won't make their Top Ten Weird Feet Of The Week.

Go see a podiatrist.
posted by It's Never Lurgi at 9:55 PM on April 24 [10 favorites]

I was going to say, as another alphabet soup person, if it were fingernails and toenails I might think psoriatic arthritis (which is related to one of my diagnoses). I have thickened toenails and splitting fingernails but it's always been both.

Since it's just your feet, I would talk to a podiatrist.
posted by gentlyepigrams at 9:56 PM on April 24 [1 favorite]

When was the last time you had a full physical with a blood sugar test?

Weird toenail problems can be a very early sign of diabetes.
posted by Jacqueline at 11:18 PM on April 24 [2 favorites]

A medical pedicure provider is what you are looking for. A local diabetes org will likely have reccs
posted by beignet at 12:24 AM on April 25 [1 favorite]

Please push through any embarrassment you may have. Doctors see body parts gone awry for a living! If you have past experiences with medical professionals that have made you feel embarrassed or upset, please know that was not okay, and that you are absolutely allowed to switch to other practitioners and never interact again with the ones who caused you discomfort.

Have you seen your primary care doctor since the pandemic? I would first suggest getting some baseline blood work done. Nail growth can be affected by many different factors that range from mundane to pretty scary. But luckily a thorough blood panel can quickly and definitively cross a lot of the scarier things off the list.

Another plus to seeing your pcp is they can answer your question more specifically about what exact kind of professional to see if it is beyond their scope, complete with referrals. I think you want a podiatrist but I am a layperson. If you are switching to a new doctor because your previous one sucked and triggered avoidance, this kind of specific issue and need for a referral or follow-up can be an excellent test for doctor/patient compatibility, instead of just showing up for a random checkup.
posted by Mizu at 12:53 AM on April 25 [3 favorites]

You know what? I think you're probably right, your dermatologist is wrong, and it is just a treatable fungus.

A study stating that the false negative rate when testing, is 30%.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5087240/

This mentions some reasons why:
https://walkwithoutpain.com.au/why-did-my-fungal-nail-infection-scraping-come-back-negative/
posted by Elysum at 2:03 AM on April 25 [6 favorites]

Go see a podiatrist, or in Canada, a Chiropodist.
posted by kschang at 7:28 AM on April 25

If you are reluctant to see somebody or are lacking options locally, you could spend a bit of time watching videos of pedicures for those with dodgy toenails. I cannot speak to how expert this lady really is but she is very good at putting people at ease about fungus and there seem to be quite a few customers who go from quite dire nail situations to normal over the course of 2-3 sessions.
posted by koahiatamadl at 9:02 AM on April 25

It sounds like a condition I had on one toe. The nail even seemed to grow faster than the others (yuuuck).

I recently took to soaking the toe in vinegar every night for 45 minutes or so and followed with a good exfoliation. After 4-5 nights my toe is looking almost back to normal. Time will tell but I am happy with the results so far :)
posted by i_mean_come_on_now at 10:55 AM on April 25

IANAD but I did have thick toenails for years, one dermatologist recommended Jublia which is wicked expensive. Eventually I went to a podiatrist (foot doctor) who prescribed Ketoconazole 2% for a year to treat the fungus. Under my Rx plan it's $18 and a tube lasts about 6 weeks. Each week (e.g., Saturday) the doctor has me file the nails with an emory board and discard it. I do see improvement as the Dr. described (new nail growth at base is translucent, old nail still shows discoloration but not as thick and less so than originally). I am 5 months in so it seems to me like the doctor's estimate is on target.

Again, IANAD, just giving you my story. Also what others said, doctors see it all. The only thing my doctor said was "You know this one toe is infected, you should have gone to urgent care instead of waiting for an appointment with me." So yeah, I was only embarrassed that I was stupid, NOT the way my feet looked.
posted by forthright at 11:27 AM on April 25 [1 favorite]

They spend most of their time in cotton socks

When I had toenail fungus (and FWIW I agree with the others here, I'm pretty sure that's what's going on with you - please don't be embarrassed, it's a common condition and VERY easily treatable, so talk to your doctor!), my doctor gave me two bits of advice:

1. Get rid of all of your cotton socks
2. Buy all new non-cotton socks. Smartwool or equivalent if you can afford them, replacement cotton for now if you can't, and slowly replace them one pair at a time with said Smartwool or equivalent.

Cotton is a wonderful fabric for many things; unfortunately, one of the things it's wonderful for is as an incubating environment for toenail fungus. Cotton does not do a good job of transporting moisture away from your feet, so your feet just sorta bathe in their own juices all day in those socks, even if you're not a particularly sweaty-footed person.

I have had great luck with Smartwool as a brand, but look for any socks that advertise themselves as "moisture-wicking" or that are built/designed for outdoor activities like hiking, cycling, running, etc. I prefer a thinner sock, so I go with the cycling/running type, but generally hiking/walking ones will be a bit thicker and have more padding if that's what you're interested in. Either way, cotton socks are not your friend as far as preventing toenail fungus.
posted by pdb at 11:58 AM on April 25 [3 favorites]

I'm on the other side of this - I destroyed my nail bed on one toe through mechanical trauma (hiking) and the toenail has never recovered, though the rest healed nicely after looking hellish for a few weeks. A pcp told me it was "definitely fungus" and wanted to treat, though I was in for something unrelated (like a covid test).

My point is that you aren't the only one, it probably is fungus, but it could also be something else (diabetes?) so its worth working up. It may be worth re-sampling or starting a course of treatment (through a new doc, at least for this if you like your derm for other things) to see how you feel.

I'm not sure why we seem to think feet are so gross, but you aren't the only one. I find it bewildering as they don't hit my squick buttons in the slightest, so if it helps, your docs probably started out not caring or got there quickly through desensitization - they aren't judging you! (And if anyone does, please step on their toes for me because shame on them!)
posted by esoteric things at 10:57 PM on April 25