Having a curved big toenail is fairly common and is usually caused by one of a few different factors. In many cases, a curved toenail is harmless and more of a cosmetic concern. However, in some instances, a severely curved nail can cause pain or increase the risk of infection. Understanding the potential causes and consulting a podiatrist can help determine the best treatment options if needed.
Quick Summary
The most common causes of a curved big toenail are:
- Improperly trimmed nails
- Poorly fitting shoes
- Injury or trauma to the nail
- Fungal infection
- Psoriasis
- Aging
While a mildly curved nail is usually nothing to worry about, severe curving, thickening, or pain may indicate an underlying problem needing medical attention. Proper nail care and hygiene can help prevent curvature in most cases.
What is onychogryphosis?
Onychogryphosis is the medical term used to describe an overgrown, thickened, and curved nail. It typically affects the big toenail but can occur in the fingernails as well. As the nail curve worsens over time, it may start to resemble a ram’s horn in severe cases.
This abnormal nail condition is more common in the elderly but can affect people of any age. The curvature is often attributed to inadequate nail care and hygiene, trauma, poorly fitting shoes, fungal infection, or medical conditions like psoriasis.
Common causes of a curved big toenail
Improper nail trimming
Habitually cutting the nails unevenly or rounding off the edges encourages the growth of one side faster than the other. This uneven growth leads to increasing curvature over time. Cutting the nails too short encourages ingrown toenails, another potential cause of curvature.
Trimming toenails straight across and leaving a little length can help keep nails growing evenly and prevent curvature. Using sharp nail clippers designed for thick toenails makes proper trimming easier.
Poorly fitting shoes
Shoes that are too tight, narrow, or short put constant pressure on the big toenail. This can flatten the nail bed over time, forcing the nail to grow outward. High heels and shoes with pointed toes are common culprits, as they compress the nail bed most.
Wearing properly fitted, looser, and protective footwear allows the nail bed room to grow straight without external pressure. Padding or inserts can also help prevent compression from ill-fitting shoes.
Injury and trauma
Injuries like stubbing the toe, fungal infections, and repetitive pressure can damage the nail bed, matrix, or surrounding skin. This disruption causes irregular nail growth as it heals, resulting in curvature over time.
Keeping toenails trimmed to prevent ingrown nails reduces injury risk. Promptly treating fungal infections prevents lasting damage. Wearing protective footwear for sports can shield from trauma. Preventing further injury supports normal nail regrowth.
Fungal infection
Toenail fungus, or onychomycosis, can cause the nail to become thickened, brittle, distorted, and separated from the nail bed. The fungal infection gradually eats away at the nail, leading to increasing curvature and deformation.
Avoiding damp public areas like pools and showers without footwear can help prevent fungal exposure. Keeping nails trimmed and dry reduces risk as well. Topical or oral antifungal medication is needed to treat an existing infection.
Psoriasis
The chronic autoimmune condition psoriasis commonly affects nail growth, causing pitting, crumbling, and abnormal thickening. The irregular nail formation leads to a curved shape over time. Psoriasis also increases fungal infection risk.
While the root cause of psoriasis is not known, keeping nails short and avoiding injury can minimize curvature. Medicated ointments, light therapy, or oral medication may help treat nail psoriasis.
Aging
As we age, nails naturally thicken and grow more slowly. Older adults often have difficulty trimming their own toenails properly. Combined with reduced circulation and ongoing compression in shoes, this encourages abnormal curving.
Regular professional nail care prevents thickening and curving in seniors. Wider, padded shoes improve comfort and reduce deformation. Addressing any underlying medical conditions improves circulation.
When to see a doctor
In most cases, a slightly curved big toenail is harmless aside from appearance. But it’s best to consult a podiatrist or dermatologist if the nail:
- Is severely thick, curved, or elongated
- Causes pain or discomfort
- Bleeds or oozes fluid
- Detaches from the nail bed
- Has discoloration or smell
These signs may indicate an underlying health condition needing medical treatment, like:
- Bacterial, yeast, or fungal infection
- Psoriasis
- Trauma or injury
- Circulatory disorders
- Diabetes
- Cancer
A podiatrist can determine if the curved nail is due to these issues or a different problem requiring specialized care. Leaving severely curved, painful, or infected nails untreated can allow the condition to worsen over time.
Medical treatment options
If an underlying condition is causing severe nail curving and pain, a doctor may recommend one of these medical treatments:
Medications
Oral antifungal or antibiotic medications treat fungal infections. Topical ointments can also be prescribed for fungal and bacterial infections. For psoriasis, steroid creams, vitamin D analogs, or retinoid creams help manage inflammation and symptoms.
Surgery
In severe cases, surgical removal of part or all of the nail (onychectomy) provides relief. This is only done when other treatments fail. Surgery removes pain, discomfort, and infection risk of a severely deformed nail.
Laser therapy
Low-level laser treatments use specific wavelengths of light to reduce inflammation and encourage normal nail growth. This helps with curvature caused by psoriasis, fungal infection, or injury. Several sessions are needed initially, then maintenance treatments.
Medicated nail lacquer
Antifungal nail polish with ciclopirox or amorolfine can treat mild fungal infections and encourage proper nail regrowth. Apply daily for about one year until healthy nail grows out. This helps prevent reinfection.
Photodynamic therapy
This treatment uses photosensitizing chemicals and light to eliminate fungus or bacteria without damaging nail cells. Studies show photodynamic therapy effectively improves severe onychomycosis after several sessions when creams alone fail.
Home care and prevention
Proper nail hygiene and care at home can prevent or minimize big toenail curving in many cases. Try these self-care tips:
Trim nails regularly
Cut or file nails straight across monthly, using sterilized nail clippers. Leave a little length to avoid ingrown nails. Trim small amounts frequently to avoid trauma from cracking or tearing.
Wear clean, dry socks
Change socks daily and avoid damp socks that allow fungi and bacteria to thrive. Cotton or wool socks absorb moisture better than synthetics.
Disinfect nail tools
Prevent spreading infection by washing clippers with soap and water after each use. Disinfect between uses by soaking in rubbing alcohol.
Apply antifungal powder
Sprinkle antifungal powder containing miconazole, clotrimazole, or tolnaftate on feet and in shoes daily to prevent fungal infection and treat early stages.
Moisturize nails and skin
Massage jojoba, vitamin E, or essential oil blends into cuticles and nails to prevent cracking and encourage healthy growth.
Avoid tight shoes
Wear properly fitted shoes with wiggle room for toes. Don’t wear high heels for prolonged periods which compress nails.
See a podiatrist regularly
Routine professional nail care prevents thickening and infection, especially for those who cannot maintain nails themselves.
When to consider nail removal
If at-home care and medical treatments fail to improve a severely distorted, painful nail, partial or complete surgical removal may be necessary. Nail removal is usually only done when:
- Significant ingrown section causes recurrent infection
- Thickening or curvature causes persistent pain
- Severe fungal infection resists all other treatments
- Gangrene develops due to restricted blood flow
- Malignant cancerous cells develop in nail
Surgery permanently removes the problematic nail cells allowing new, healthy growth. It brings immediate pain relief and infection prevention in severe cases. However, the nail may look abnormal or not regrow at all after, requiring an artificial nail.
What’s the outlook for a curved toenail?
With proper nail hygiene and care, a mildly curved nail can regrow normally over time. For severe curvature, underlying medical treatments allow the nail to realign as it regrows. Permanent nail removal may be needed in some cases for pain relief or to deter infection.
While a severely curved nail can take a year or more to grow out, the outlook is good with consistent care. Some underlying conditions like fungal infections may require lifetime management though.
Consulting a dermatologist or podiatrist can determine the cause and appropriate treatment for abnormal nail curving. Seeking medical care prevents minor issues from progressing to irreversible nail damage or deformity.
Conclusion
A curved big toenail is commonly caused by improper trimming, poorly fitting shoes, injury, fungal infection, psoriasis, or aging. Mild cases can be managed with preventive nail hygiene and care. More severe curving or pain should be examined by a podiatrist.
Underlying medical conditions may require antifungal medication, surgery, or laser therapy to enable normal nail regrowth. With consistent professional treatment, even severely distorted nails have a good outlook. Prompt care prevents progression to permanent deformation or removal in most cases.