What is Onycholysis?

Your feet take a pounding with the average adult walking almost 75,000 miles over their lifetime. That’s more than three times around the globe and all those steps take a toll on our toes which can suffer from a variety of conditions and ailments.

One such common condition, onycholysis, occurs when your nail separates from its nail bed.

Onycholysis can be the result of many underlying causes but in toenails the cause is typically trauma or repetitive impact against shoes during walking or running.

“Onycholysis is the separation of a fingernail or toenail from its pink nail bed.

The separation occurs gradually and is painless,” explains Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing. “The most common cause of onycholysis is trauma. Even slight trauma can cause onycholysis when it happens repetitively.”

Onycholysis is usually painless, but the condition can be stubborn, lasting for several months or longer than a year.

Since onycholysis can be caused by other conditions such as iron deficiency, hyperthyroidism, nail psoriasis, and fungal infections, those suffering from nail separations may want to see their healthcare provider if they do not know the cause of their onycholysis.

Here’s a closer look at the causes of onycholysis, the symptoms of the condition, how it is diagnosed and treated, and how you can prevent it from happening.   

Causes of Onycholysis

Trauma is the most likely factor to cause onycholysis in your toenails but there are many other causes of this condition:

• Trauma: The most common cause is repetitive trauma, such as stubbing the toe or wearing ill-fitting shoes that put pressure on the nails.
  
  
• Fungal Infections: Onychomycosis, a fungal infection of the nail, can lead to onycholysis.
  
  
• Chemical Exposure: Harsh nail care products or cleaning agents can irritate the nail and lead to separation.
  
  
• Skin Conditions: Certain systemic conditions can contribute to nail separation. Allergic reactions and psoriasis are also common causes of the condition.
  
  
• Other Conditions: Iron deficiency, anemia, hyperthyroidism, diabetes and other conditions can cause onycholysis.
  
  
• Medications: Some medications can induce onycholysis, especially those that cause photosensitivity.
  
  
• Moisture Exposure: Prolonged exposure to water or humid environments can weaken the nail’s attachment to the bed.

“Some medical conditions can cause onycholysis, generally by changing the nail's shape or the contour of the soft tissue bed beneath it. In these situations, the nail cannot attach smoothly to the nail bed,” says Harvard Health.

Research archived in the National Library of Medicine cautions that in some cases, no underlying cause can be found.

Symptoms of Onycholysis

So how do you know if you have onycholysis? Here are the primary symptoms of the condition:

• Nail Separation: The most obvious sign is the visible separation of the nail from the nail bed, often starting at the tip or sides.
  
  
• Discoloration: The separated part of the nail often appears white or opaque due to air trapped between the nail and the bed.
  
  
• Thickening: The affected nail may become thicker than normal.
  
  
• Brittleness: The nail might become more brittle and prone to breaking or crumbling.
  
  
• Mild Discomfort: While onycholysis is typically painless, some patients may experience mild discomfort or sensitivity in the affected area.

Explains Harvard Health: “Depending on the cause of onycholysis, the nail may have collected thickened skin underneath the edge of its nail plate, and the nail plate may have a deformed shape with pits or indentations in the nail surface, a bent nail edge or coarse thickening of the nail.”

How is Onycholysis Diagnosed?

Diagnosis of onycholysis is primarily clinical – done by your doctor based on the appearance of your nails and your patient history. However, additional tests may be necessary to determine the underlying cause:

• Visual Examination: A podiatrist will carefully examine the affected nail and surrounding skin.
  
  
• Nail Clippings: Samples may be taken for fungal culture or microscopic examination if a fungal infection is suspected.
  
  
• Blood Tests: These might be ordered to check for systemic conditions like thyroid disorders or diabetes if suspected.
  
  
• Onychoscopy: This specialized examination uses a dermatoscope to closely inspect the nail and can help differentiate between various nail conditions.

“Your doctor will be able to confirm that you have onycholysis by examining your fingernails or toenails. If the cause of onycholysis is not obvious, your doctor will note additional characteristics of your nails, such as their shape and color, the presence of indentations in the nail surface, and the appearance of the skin under and around the nail,” says Harvard Health.“He or she also will examine you to check for evidence of skin rashes or thyroid problems. If your doctor suspects that a fungal infection is the cause of nail changes, he or she might scrape a sample of tissue from beneath the nail plate. This sample can be tested in a laboratory to check for fungus.”

Treatment of Onycholysis

Treatment options for onycholysis depend on the cause of the problem. Keep in mind that the nail that has detached already from the nail bed will not reattach itself, and new nail growth must occur.

Here are some treatment options:

• Trimming: The separated portion of the nail should be carefully trimmed away to prevent further trauma and reduce the risk of infection.
  
  
• Keeping Nails Dry: It's crucial to keep the affected nail and surrounding area clean and dry to prevent bacterial or fungal growth.
  
  
• Topical Treatments: Antifungal or antibacterial medications may be prescribed if an infection is present.
  
  
• Systemic Medications: In some cases, oral antifungal medications might be necessary for fungal infections.
  
  
• Treating Underlying Conditions: If onycholysis is due to a systemic condition or skin disorder, treating that condition is essential.
  
  
• Avoiding Irritants: Patients should avoid harsh nail products and protect their nails from chemical exposure.
  
  
• Proper Footwear: Wearing well-fitting shoes that don't put pressure on the nails is important for prevention and treatment.

How to Prevent Onycholysis

Preventing onycholysis, especially in the toenails, starts with proper foot care and choosing the right footwear.

Here are some strategies to avoid the condition:

• Footwear Choice: Wear shoes that fit well and don't put pressure on the toenails.
  
  
• Regular Foot Checks: Regularly inspect your feet and nails for any signs of problems.
  
  
• Protective Measures: Use protective footwear in public areas like swimming pools to prevent fungal infections.
  
  
• Proper Nail Care: Keep nails trimmed and avoid aggressive manicuring techniques.
  
  
• Moisture Control: Keep feet dry and change socks regularly, especially if feet tend to sweat excessively.
  
  
• Gentle Nail Products: Choose nail care products that are free from harsh chemicals.
  
  
• Healthy Diet: Maintain a balanced diet rich in vitamins and minerals that support nail health.

When to Seek Help from a Podiatrist

While onycholysis is not a medical emergency, and some mild cases might resolve on their own with homecare, it can be important to consult a podiatrist to make sure your condition is addressed properly.

The Cleveland Clinic says you should contact your podiatrist or healthcare provider when:

• Onycholysis appears along with other serious symptoms, including fatigue, feeling cold, dizziness or weakness, headaches, a sore tongue and a fast heartbeat.
• Your symptoms don’t improve after treatment.
• The skin around your nails looks infected (red, purple, gray or white skin; irritation and swelling).

At Sweeney Foot & Ankle our doctors are experts in treating foot and ankle pain and discomfort, including conditions affecting your toes and toenails. Contact us today to keep your feet healthy and happy.