Toenail Fungus and Anatomy

Understanding the Toe: normal toenail anatomy and common nail disorders

toenail fungus doctorBoth toenails, fingernails and hair are made from keratin, a type of structural protein. As a protein, keratin is unique and differs greatly from the proteins which make up muscle tissue. This substance is indigestible, hard, shiny, and unusually durable.

The specialized cells which create keratin are found at the base of the nails and within hair follicles. As these cells multiply, more keratin is deposited in layers and hardens almost instantly. At a steady, predictable rate the corresponding hair and nails grow.

Note that the characteristics of the final nail can vary considerably. Traits such as growth rate, strength, and nail stiffness are largely due to heredity. As such, several relatively common podiatric conditions are influenced by these various growth tendencies.

normal toenail anatomy

The following structures and functions correspond to the 6 different regions of the nail.

1.    The nail matrix: this refers to the living, biologically active part of the nail. The toenail matrix is responsible for producing structural units formed from the protein keratin. As new nail material is added it pushes the existing material forward, forcing the nail to lengthen.

2.    The nail plate: this is the technical term for the nail itself.

3.    The nail bed: the portion of living skin tissue beneath the nail plate.

4.    The lunula: this is the small moon-shaped crescent which appears at the base of the plate. It’s normally a lighter color and may appear entirely white.

5.    Nail folds: these specialized grooves hold the nail in place against the skin as it grows.

6.    The nail cuticle: this refers to the thin layer of tissue which collects at the margins of the nails as they grow from the skin.

Common growth problem—toenails which grow upwards:

Due to their natural shape human toenails almost always grow downwards. The reverse can occur as well, however, and is simply known as a vertical nail. This can occur for a variety of reasons:

  • A patient’s genetically determined growth pattern.
  • Poorly fitting footwear, i.e. an overly tight toe-box.
  • Chronic dampness caused by profuse foot sweating.
  • As a result of injury.

Also note that several less-common conditions can result in the formation of a vertical nail.

Treating vertical toenails

You should consult a podiatrist when you first begin to believe that your nails aren’t growing in normally. He or she will be able to determine if you’ve got onychogryphosis, koilonychia, NPS, or another nail condition.

Regardless of your doctor’s findings it’s essential for patients to maintain proper foot hygiene and nail care. Vertical toenails tend to rip away more often which can open the gates for bacterial or fungal infections. The most important part is simply trimming the nails close using a clean, sharp clipper. Cut straight across—not curved—in order to prevent the nail from growing inward.

Always cut the nails when they are clean and dry as dry nails are less likely to crack. Other tips include:

  • Inspect your nails at least once a week. You don’t necessarily need to clip them this often but by checking you can become aware of any ongoing changes.
  • Use the other end of the clipper to scrape dirt out from under the nail.
  • After cutting the nails wash the feet thoroughly with soap and warm water. Then towel dry.
  • After bathing be sure to use a high quality moisturizing lotion on the feet. Massage into the nails and cuticle when applying.
  • Smooth the rough edges of a freshly clipped nail using an emery board or file. This will prevent them from catching on socks or other clothing.
  • Wear clean, dry socks and change at least once daily. Note that natural cotton socks are preferable as they wick away sweat more efficiently.
  • Wear high quality, sports-specific footwear when active.
  • Don’t go barefoot in warm, damp public places such as swimming pools and locker rooms. Wear sandals or flip-flops instead.

Toenail Fungus and Anatomy and Nail Diseases

Onychogryphosis:

This is a general term which refers to the thickening of the toenails. Causes vary by case, with injury and infection being the most common. All nails may be effected but the condition is most commonly seen on the big (1st) toe. Due to the resulting shape the condition is informally referred to as “ram’s horn nail” or “claw nail” by many clinicians.

Nail-patellar syndrome:

This genetic disorder is most often referred to simply as NPS. The severity of the condition runs a wide spectrum, and indeed all NPS patients present with some nail abnormalities. Those with more pronounced physical defects are also likely to experience abnormalities of the elbow, knee, and hip joints. Note that NPS patients are also at an increased risk of developing various kidney diseases.

Koilonychia

This deformity presents as overly thin, fragile nails with a distinctive spoon-shaped appearance. In the majority of cases koilonychia is thought to be genetic in origin. Iron deficiency (anemia), celiac disease, and hypothyroidism are also suspected causes. Patients with an iron-absorption disorder known as hemochromatosis also frequently develop koilonychia.