Why Is My Big Toenail Falling Off, and What Can I Do About It?

Though you may be shocked to see the nail on your big toe sliding off its nail bed, or even missing entirely, losing a toenail is more common than you think. Runners and other high-powered athletes who batter their feet in competition are most likely to lose a toenail, but it can happen to anyone.

Mark Forman, DPM, MBA, FAPWCA, is a leading podiatrist and the owner of Put Your Feet First in Scottsdale, Arizona. Following are some common reasons why big toenails fall off partially or entirely, and what you should do about it.

You injured your toe

If you drop a cast-iron pan or other heavy weight on your toe, you don’t easily forget that moment of intense pain. Later, your toenail turns black and falls off. You’re dismayed, but not exactly surprised.

However, if you stub your toe while rushing around (with or without shoes), you may not even notice. Adrenaline kicks in, you’re busy, and even if you yelped in pain at the moment, you quickly forget the incident. Then your toenail darkens and falls off, and you wonder why.

You could also injure your toe in a car accident, a fall, or during sports or another intense activity. About 2.5% of marathon runners, not surprisingly, develop a subungual hematoma, which is a bruise or bleeding in the blood vessels directly under the nail bed that makes your toenail look black and pushes it off the nail bed.

As long as no more than 25% of your toenail is affected, you probably don’t need treatment. Steps for at-home subungual hematoma care include:

  • Clipping or filing any sharp edges on the nail
  • Cleaning the nail bed
  • Soaking the toe in cold water for 20 minutes
  • Elevating your foot when possible
  • Covering the nail bed with antibiotic ointment
  • Applying a bandage daily for 7-10 days
  • Taking over-the-counter painkillers

If more than 25% of your toenail is affected, or if your pain doesn’t improve in a day or two, give us a call. If the nail hasn’t fallen off entirely, but the portion that’s left on the bed catches on your socks or is painful, Dr. Forman removes it safely and painlessly at our office.

Once your nail has detached from the nail bed, it can’t reattach itself. Your toenail may take from 6-24 months to grow back completely.

You have a nail fungus

A nail fungal infection, known as onychomycosis, is one of the most common reasons that toenails detach from the nail bed and fall off. You’re at risk for a nail fungal infection if you have pedicures in a salon that doesn’t sterilize instruments between clients or doesn’t sterilize foot baths properly, or if you have diabetes.

You can also catch a fungal infection at the gym or pool, or simply from having sweaty feet. Keeping your feet clean and dry minimizes your risk for an infection.

Toenails with fungal infections look:

  • Flaky or pitted
  • Covered with white, brown, or yellow spots
  • Crumbling, especially at the corners
  • Smell bad
  • Thickened
  • Dry and brittle
  • Unusually shaped
  • Scaly under the nail

Some symptoms of a nail infection are also present for other conditions, including psoriasis. That’s why Dr. Forman recommends coming in for a diagnosis. Once he knows what has caused your toenail to degrade or fall off, he chooses the right treatment for you.

If you do have a fungal infection, he may recommend oral or topical antifungal medications. He may also use FDA-approved laser therapy to kill the fungus and allow your nail to grow back, fungus-free. Over-the-counter antifungal treatments may work temporarily, but the infection usually recurs.

You have psoriasis

The skin condition psoriasis can cause changes to your fingernails and toenails, too. Psoriasis is an autoimmune disorder, which means your body mistakenly attacks healthy tissue, such as skin cells and nail cells. The cells in your finger or toe skin actually produce nails by pushing out and compacting skin cells, until they harden as a protective, keratin-rich protective barrier.

When you have psoriasis, your skin produces new cells before it sheds the old ones. Over time, your skin may develop thick, rashy patches known as plaques that could take on a silvery look due to the layers of old skin cells. When psoriasis affects the skin underneath your nails, the plaques push against the nail, loosening it.

Toenails that are affected by psoriasis may have the look of a fungal infection. You might notice:

  • Pitting
  • Discoloration
  • Thickening
  • Unusual nail shape
  • Chalkiness and flakiness

However, psoriasis in your nails shouldn’t have a foul odor, as they might with a nail infection. They may also hurt.

If your toenail is missing, contact us for diagnosis and treatment. Call our office in Scottsdale, Arizona, at 480-423-8400 for an in-person or telehealth appointment, or request an appointment online. You can also contact us here on our website.

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