How to Achieve and Maintain Healthy Toenails

Summer is here! Time to fully embrace open-toed footwear. While this change is relieving and exciting for some, if you’ve battled thick or discolored nails this can be an unwelcome adjustment. If this is not a happy time for you, our hope is to turn a potentially embarrassing season into a pleasant one. To do this, we will explore the reasons behind nail disorders, as well as share some easy and inexpensive homecare remedies.

Understand Nail Health

Before we jump into the specifics of poor nail health, it’s important to have a clear understanding of the nail itself. Toe and finger nails are composed of densely packed keratinized cells. They grow approximately 1mm per month, from the root, with the nail bed extending along the top of the last digit. The boundary of skin and the free end of the nail is known as the hyponychium, which provides a protective barrier along the nail edge. Nail composition includes roughly 7-12% water, and the surface is remarkably permeable. Nail health can be impacted by a variety of factors including diet, systemic health, trauma, fungus, yeast or mold. Aesthetic signs of a nail problem will include nail thickening or nail discoloration (frequently white or yellow). Because of the vast variety of factors that impact nail health and appearance, it can be difficult to determine root cause. In light of this, we’ll be exploring two of the most common causes.

Dystrophic Nails: 

Nails that are exposed to trauma in the form of sudden impact, repetitive friction, rubbing or pressure will be subject to structural changes. For example, when tissue is exposed to repetitive motions that rub or squeeze, cells often thicken to protect themselves. Calluses then begin form as a response to the frequent pressure and friction. When toenails are squeezed within a narrow toe box and repeatedly rub against each other and the fabric of the shoe, this triggers the nail bed to form tougher, thicker layers of cells. This can cause a toenail to look yellow, slightly darkened and thick.

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 Mycotic Nails:

Nails that are infected with a fungus (onychomycosis) will also thicken and discolor. Fungi live within our environment, and sometimes even on our skin. The presence of fungi is not always harmful and may go unnoticed due to lack of irritation or any apparent symptoms. Fungi can become a concern under the right circumstances, specifically a dark, moist and warm environment. Combined with a little rubbing, friction and squeezing, warm and moist skin will begin to break down on a microscopic level. Small cracks will begin to form in predictable areas of friction: between the toes, along cracked heels, at the end of the nail and the nail bed (hyponychium). At these areas where skin breaks down, fungi can seek protection and ‘burrow’ into small crevices. The deeper fungus travels into skin folds or under nail beds, the more difficult it is to treat.

The most common fungus that impacts nail health, Tinea Pedis, is commonly known as Athlete’s Foot. Tinea Pedis can be found on most surfaces, and loves environments that are warm, moist and dark (like our footwear). Tinea Pedis is also slightly mis-understood, or mis-represented by drug companies. Touching it does NOT mean you will get athlete’s foot. While there are a multitude of factors that can lead to proliferation of Tinea Pedis, it shouldn’t be treated like a contagious disease. Genetic factors like your skin’s biochemistry may make your skin more suitable or desirable to certain fungi, as some feet will sweat more. There are also environmental factors to consider, like a worker or athlete that is unable to take off footwear for a 12 hour shift or a long practice. Fungi also prefer certain materials and fabrics, which you may be wearing unknowingly. Given these genetic and environmental factors, just because you are exposed to or contact fungus doesn’t mean that you will end up with a fungal infection. However, if Tinea Pedis does tend to favor your skin biome, here are some DIY tricks to manage skin and nail health.

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How to make toe nails healthier

1. Let your feet breath.

Remove shoes while seated at your desk or when you come home from work. Exposing feet to air frequently prevents moisture build-up and keeps feet dry.

2. Expose feet and nails to the sun.

UVB is a natural germicidal agent, so with sunny days on the horizon go ahead and let those toes see the light of day.

3. Remove nail polish and other barriers to the nail bed.

Nails need to breath to be healthy. Polish not only obscures airflow to the nail, it also prevents other anti-fungal methods like sunlight or topical medications from working. If you must paint your nails, try Just for Toenails Polish. It’s a safer and more natural alternative.

4. Avoid cotton socks.

Cotton traps moisture and harbors fungus easily. Instead, wear socks composed of natural wicking materials like merino wool or bamboo, and those with moisture wicking technology (example: CoolMax®).

5. Wear shoes that are naturally shaped.

When you have to wear shoes, using shoes that allow toes to spread and avoid toe compression will help prevent friction or rubbing against the edge of the nail.

6. Decrease nail bulk.

Debriding nails is the process of trimming and thinning nails. While nail debridement is a common procedure within podiatric offices, you can also use nail clippers and an Emory Board to clip and thin nails at home. Thinning nails helps to remove infected nail bulk, while also exposing the healthy part of the nail to allow either topical medications or sunlight to work faster.

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7. Apply topical antifungal creams.

Once the nail is thinned and trimmed, apply topical antifungal cream 5 nights a week to clean, dry skin. Once medication is applied to the nail bed, cover each nail with plastic wrap. This ensures that cream remains on the toe, and prevents the cream from soaking into socks or bed sheets.

Note: Do not use cloth bandages or Band-Aids, as cotton will soak up medications. For active infections, topical antifungals should be used consistently until the entire nail is healthy. Prophylactic medication use may also be recommended on a bi-monthly (ongoing) basis to prevent future fungal growth. For topical treatments to be helpful, the nail must be debrided first.

Depending on the cause of your nail discoloration or thickening, the above steps may only be a small portion of your recovery. It’s important to realize that regardless of the causes, regeneration and growth of a healthy nail will take time. Toenail growth is slow, averaging 1mm per month in length. Full re-growth of a big toenail may take upwards of one year’s time. As you begin to change sock fiber type, footwear shape, introduce nail debridement or topical medications, you may not see full resolution for months. A complete cure can sometime be a lifelong commitment of continuously protecting nails from excessive rubbing and friction, or establishing a routine that keeps feet free of moisture and factors that encourage fungal growth. For a detailed explanation and understanding of your specific nail health concerns, it may be necessary to check with your physician. For common and basic nail needs, we hope the above steps are a positive part of your recovery and health. For other foot and nail health tips and tricks, please visit:

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About the Author: Tung Chi