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The Truth About Thickened Toenails

Thickened_toe_nails_One of the most common anomalies we see in the clinic is thickened toenails. This condition is also known as onychochauxis, onychogryphosis, or more generally, hypertrophied nails.

Presentation

Thickened nails are developed over a period of time. The nail may appear as slightly thickened plate, or to a more extreme “ram’s horn”- like anomaly. It may also have varying densities. These nails may also appear to be a different colour. This may be a result of the increased layers of the nail plate, a change in density of the nail plate, a secondary infection within the nail plate, or a poorer quality of nail plate associated with an underlying medical condition.

Causes Of Thickened Nails

Most commonly, a nail which is only moderate thickened or hypertrophied, will be a result of micro trauma. If all ten of the nails plates are affected similarly, a systemic cause is considered (such a diminished circulation, or a response to an oral medication). If only one or two nail plates are affected, a diagnosis will more likely be made in relation to microtrama, direct blunt trauma or infection.

Microtrama may be described as a continued, repeated irritation over the end of the digits, commonly by ill-fitting footwear. Clawed or malaligned digits may also contribute to this microtrama. The patient will often not feel this trauma while it is occurring.

Blunt trauma will be obvious. This may be a simple as dropping a heavy object on your toe, or kicking your toe hard enough to lift the nail plate from the nail bed. Occasionally bruising can occur subungually (under the nail plate) or within the layers of the nail which will also discolour the nail. Unfortunately a bruise in the nail plate does not fade like a bruise on our skin does, and will slowly grow out with the nail over an extended period.

An infection may present as a yellowish, chalky nail plate, and most commonly be fungal (although other microbes and bacteria can also invade the nail plate).

Ultimately, once the nail bed has been damaged, or the area behind the nail from which it grows (called the matrix) is damaged, the thickened nail plate may not be able to be cured. Treatment such as reducing the elongated and thickened nail plate with speciality equipment we have in clinic will provide a short term solution, however as the nail continues to grow, the thickening will most likely return in the nail plate. The resolution of any underlying iIMG_9187nfection may result in the return of a healthy thin/ flat nail plate.

Thanks for reading, Carissa

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Shop 2/17-19 East Parade
Sutherland, NSW 2232

Tel: 02 9542 3491
Email: info@sutherlandpodiatry.com.au