Thick Toenails: 5 Causes and a Bunch of Treatments

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Several people have asked what to do for their thick toenails. And to tell the truth, it’s not a trivial question. Thick toenails can be the starting point for bad bruises, infections and even gangrene. In a disaster situation, these problems could become more likely if you have to do a lot of walking or even just standing. If your shoes press on the toenail, the toe can become quite bruised. Then, if your toes swell from the bruising, the shoes will be tighter on them, causing a dangerous cycle, even to the point of killing some of the tissue under the nail.

So it’s best to treat thick toenails before a disaster rather than during.

5 Causes of Thick Toenails

1. Fungi. A fungus is a common cause and hard to get rid of.

Treatment: You can try daily application of:

Tea-tree oil, an antifungal
Topical antifungals bought at the drugstore; the label will say they’re for toenail fungus

Other options include daily 15-minute vinegar and water soaks (one part vinegar, two parts water) or prescribed oral medicine.

Whatever method you try, it usually takes a few months before you see improvement. A new (and expensive) way to treat fungus is to go to a laser treatment center. This is quick and the most likely to be effective, but the fungus often comes back no matter the treatment, especially once you stop it.

2. Poor circulation. There are many chronic diseases that affect circulation. One of the most common is diabetes. As anyone with diabetes knows, with or without thick toenails, you have to always pay particular attention to your feet by wearing shoes that fit well and keeping your toenails clipped well. Any little infection, from rubbing or whatever, can lead to a serious infection quickly. The thick toenails that come from poor circulation just add to the risk.

Treatment: This one’s more about prevention. Keep the diabetes as well controlled as possible to prevent the poor circulation. Also, if you have diabetes, please don’t smoke. Of course that’s bad for anyone’s circulation, but it can be the last straw before losing a limb in someone with diabetes.

Remember, people with poor circulation often have decreased feeling in the feet. It’s essential to wear good-fitting shoes and inspect your feet once or twice or more a day for blisters or abrasions you may not be feeling.

To complicate matters, many people with poor circulation have a fungal toenail infection that’s also causing the toenail thickening that needs to be treated.

3. Eczema, a disease causing the skin to be chronically irritated and inflamed

Treatment: You can try some of the treatments listed in the fungus section, or maybe use some over-the-counter hydrocortisone on the nails to counter the irritation and inflammation, but really, usually nothing works very well.

4. Psoriasis, a disease that causes patches of thick red skin covered with silvery scales.

Treatment: Treat the underlying psoriasis. Nothing special helps the toenails.

5. Genes. Some people are just born with a tendency for thick toenails. There’s no infection or disease, so there’s no cure.

Living With Thick Toenails

No matter your best efforts, the thick toenails may stick around for you to deal with the best you can. The best alternative may be simply to try to prevent damage from them:

  1. Soak your feet regularly with warm water for 15 minutes.
  2. Dry off your feet.
  3. File down the thickness with a nail file or emery board.
  4. Clip the ends with strong toenail clippers.*

Be careful not to be too aggressive and make yourself bleed.

What about you? Have you tried any of the treatments? Did they work? Do you have one not listed that did?

By James Hubbard, MD, MPH

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