Having hard toenails is a common issue that many people experience. The hardness is often caused by a buildup of keratin, which is a protein that makes up the main structure of nails. While hard toenails are rarely a serious medical issue, they can lead to pain, discomfort, and problems with proper toenail trimming and care. Understanding the causes of hard toenails and following proper treatment can help restore healthy, comfortable toenails.
What causes hard toenails?
There are several potential causes of abnormally hard or thickened toenails:
- Fungal infections – One of the most common causes of hard toenails is a fungal infection of the nail, known as onychomycosis. Fungi can infect the nail bed and plate, leading to thickening, discoloration, brittleness, and debris buildup under the nail.
- Trauma – Injuries, tight shoes, improper nail trimming, and repetitive pressure on the toes can damage nails and disrupt normal growth. This can cause the nail to thicken and harden as a protective response.
- Poor circulation – Reduced blood flow to the extremities can affect nail growth and cause the nails to become dehydrated, inflexible, and hardened.
- Nutritional deficiencies – Lack of key nutrients involved in nail health, like biotin, vitamin C, and zinc, may lead to brittle, rigid nails.
- Nail disorders – Medical conditions like lichen planus, psoriasis, and eczema can directly affect the nail matrix and disrupt normal keratin production and development, resulting in hardened nails.
- Aging – Nails tend to thicken and develop ridges as part of the normal aging process.
- Genetics – Some people are simply prone to developing thicker nails due to hereditary factors.
- Dehydration – Chronic dehydration can cause nails to become dry and rigid.
- Diabetes – Poor blood sugar control in diabetics is associated with nail disorders like Candidal onychomycosis that can lead to hard, brittle nails.
- Medications – Certain medications, like retinoids, beta blockers, and chemotherapy drugs, may produce nail hardening as a side effect.
In most cases, hardened toenails develop due to a combination of factors. Fungal infections, repeated trauma, poor circulation, and nutritional deficiencies are among the most common underlying causes.
Signs and symptoms
Hard toenails can manifest with various signs and symptoms, including:
- Thickening – The nail becomes abnormally thick and rigid.
- Discoloration – The nail may become yellowed, streaked, or opaque.
- Splintering – The edges of the nail may split or peel.
- Brittleness – The nail feels dry and prone to cracking or breaking.
- Buildup under nail – Debris, fungal material, or detached nail material builds up under the nail plate.
- Distorted shape – The nail may become domed or concave due to uneven thickening.
- Liquid-filled lesions – Small blisters containing reddish fluid called onycholysis may form under the nail.
- Crumbly texture – A chalky, loose texture within the nail.
- Discomfort – There may be pain, sensitivity, or pressure, especially when wearing shoes.
- Detachment – Part or all of the nail may separate from the nail bed.
One or several of these signs may point to an underlying issue leading to abnormal hardening. The largest toenails on each foot are most commonly affected.
When to see a doctor
In most cases, hard toenails do not require emergency care. However, it is advisable to see a podiatrist or dermatologist if:
- The nails become extremely thickened or deformed.
- There are signs of an infection, like foul odors, drainage, swollen/red skin, streaking red lines, increased pain or throbbing.
- There is persistent discomfort or problems walking.
- Thickened nails are interfering with proper trimming.
- Your immune system may be compromised from medication or disease, increasing infection risk.
- Diabetes is present and toenail changes develop.
- You have circulatory disorders like peripheral arterial disease.
- Nail fungus or discoloration fails to clear with over-the-counter treatments.
- The skin around the nail shows symptoms of fungal infection or other disorder.
A podiatrist can properly diagnose the underlying cause and provide specialized treatments to restore healthy toenails.
Diagnosis
To determine the reason behind hard toenails, the podiatrist will typically:
- Ask about your symptoms and medical history.
- Examine your toes and feet for signs of fungal infection or other abnormalities.
- Check for impaired circulation in the lower extremities.
- Have a sample from beneath the nail analyzed under a microscope for presence of fungus.
- Order blood work or other testing to assess for underlying conditions like nutritional deficiencies, arthritis, psoriasis, or diabetes.
- Possibly order a biopsy to examine a piece of the nail if the diagnosis remains unclear.
Once the cause is determined, appropriate treatment can be initiated to soften the nails and address the underlying problem.
Home remedies and lifestyle tips
While medical treatment is often necessary for hard nails, some home care techniques may help improve nail texture, reduce discomfort, and support treatment:
- Soak nails – Soaking the feet in warm water with antibacterial soap or Epsom salt can soften nails and allow easier removal of debris.
- Apply oil – Massaging jojoba, coconut, or vitamin E oil into nails and cuticles helps hydrate and gently soften.
- Trim nails properly – Use sharp nail clippers or files to carefully trim nails straight across; avoid rounding edges or shortening too much.
- Protect nails from injury – Wear properly fitted shoes and socks. Don’t pick at nails or expose them to repeated trauma.
- Treat fungal infections – Apply over-the-counter antifungal creams containing ingredients like clotrimazole, miconazole, or tolnaftate.
- Improve circulation – Regular exercise, stretching, massage, and avoiding prolonged standing/crossing legs allows better blood flow to the feet and nails.
- Eat nutrient-rich diet – Consume foods high in vitamins A, C, D, zinc, iron, and biotin to support nail health.
- Stay hydrated – Drink plenty of water to keep nails flexible and prevent brittleness.
- Avoid harsh chemicals – Limit use of nail polish remover, detergents, and cleaning agents that can dry out nails.
- Wear comfortable shoes – Shoes that are too tight can put pressure on toes and contribute to nail damage.
- Don’t hide nails – Avoid using artificial nails or nail polish that can mask underlying nail problems.
While these methods may provide temporary relief in mild cases, seeing a doctor is still recommended to address the root cause and prevent recurrence.
Medical treatments
A doctor may prescribe the following medical treatments for hard toenails depending on the underlying cause:
- Medicated nail creams/solutions – Prescription antifungal lacquers containing ciclopirox or amorolfine can penetrate nails to eliminate fungal infections.
- Oral antifungal medication – Drugs like terbinafine or itraconazole may be prescribed for stubborn fungal nail infections.
- Laser therapy – A laser can selectively target and damage fungal material under the nail to clear infections.
- Surgery – In severe cases, surgical removal of part or all of the nail (nail avulsion) may be performed.
- Medications – Drugs that improve circulation or treat conditions like psoriasis may be prescribed.
- Nail debridement – Regular trimming and thinning of the nail plate can help reduce thickness.
- Prescription vitamin supplements – Vitamins, nutrients, and supplements to address deficiencies.
Successfully treating any underlying disease and improving nail hygiene practices are key to managing hardened nails. Follow your doctor’s instructions carefully for any prescribed treatments.
Complications
While hardened nails themselves are rarely dangerous, they can lead to complications like:
- Ingrown toenails – Hardened nails are more likely to curve downward into the skin, causing ingrown toenails.
- Permanent thickening – Without treatment, some causes of nail hardening like fungus can persist and lead to permanent deformity.
- Infection – Fungal infections may spread to the skin if left untreated.
- Walking difficulty – Excessive thickening can press on shoes and make walking uncomfortable.
- Diabetic foot problems – Hardened nails in diabetics increase risk of ulcers and other diabetic foot complications.
- Pain – Severely thickened, ingrown, or split nails can be very painful.
Seeking appropriate treatment helps avoid complications and restore normal toenail thickness and appearance.
Prevention
You can take these preventive steps to reduce the chances of developing abnormal hardening:
- Practice good toenail hygiene – Keep nails trimmed straight across and avoid injuring the nail bed.
- Treat minor fungal infections promptly – Use antifungal creams at the first sign of infection.
- Disinfect nail tools – Clean tools with alcohol after each use to avoid spreading infection.
- Avoid walking barefoot in public areas – Wear flip flops in locker rooms, pools, etc. where fungal spores may be present.
- Wear moisture-wicking socks – Change socks frequently if your feet sweat excessively.
- Don’t share pedicure tools or nail polish – Always use sanitized instruments.
- Wear properly fitted shoes – Prevent repeated mechanical stress and injury to nails.
- Manage medical conditions – Control chronic issues like diabetes, peripheral arterial disease, psoriasis that can affect nails.
- Eat a balanced diet – Ensure adequate intake of nutrients involved in nail formation.
- Limit acrylic nails – These don’t allow nails to breathe and be inspected.
While some causes are unavoidable, paying close attention to nail care and foot health can help reduce the chances of developing hardened toenails.
When to see a doctor
See your doctor if you experience any of the following symptoms:
- – Extreme nail thickening or distortion
- – Signs of infection like swelling, redness, oozing, foul odor
- – Increased pain or throbbing in the toe
- – Hardened nails interfere with proper trimming
- – You have a weakened immune system or diabetes
- – Poor circulation in the lower limbs
- – Over-the-counter antifungals fail to resolve discoloration or fungal signs
- – Skin around the nail shows infection or abnormality
A podiatrist can diagnose the underlying cause and provide appropriate treatment to restore healthy nails.
Key points
- Common causes of hard toenails include fungal infection, repetitive injury, poor circulation, nutritional deficiency, and disorders like diabetes.
- See a podiatrist promptly if nails become extremely thick, distorted, or infected looking.
- Soaking, hydrating, trimming nails properly, and treating fungal infections help manage symptoms.
- Medical treatments like antifungal medication, laser therapy, surgery, or prescription supplements may be needed.
- Practicing good foot hygiene and staying vigilant for fungal infections helps prevent recurrence.
The bottom line
Hardened toenails are often due to a fungal infection or mechanical damage to the nail. While not typically a medical emergency, proper diagnosis and treatment by a podiatrist can help resolve symptoms and restore healthy looking nails. With good preventive foot care, thickened nails can often be avoided.
