Toenail Falling Off: Causes, Symptoms and Treatment Options

Toenail Falling Off: Causes, Symptoms and Treatment Options
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A toenail that falls off can leave you with an unsightly toe that can cause embarrassment. The medical name to describe a toenail that separates from its nail bed and falls off is onycholysis or onychoptosis. The most common causes of this nail disorder are fungal infection or a toenail injury. However, other types of infections and skin conditions can also cause the toenail to break off. Before the toenail falls off, you may also notice signs of damaged toenail such as it becoming thick, crumbly, and discolored.

There isn’t much you can do when a toenail falls off apart from waiting until it grows back, which may take up to 18 months. However, there are some natural ways to treat thickened toenails to prevent them becoming loose, separating, and eventually dropping off. For example, tea tree oil can kill off fungal infections and stop a toenail crumbling and breaking off. Also, keeping your feet dry can help to prevent fungal and other infections from damaging your toenails.

This article looks at the various reasons why toenails can fall off and what you can do about it. You will learn that there are more reasons than just toenail fungus and trauma to blame for toenails separating from the bed and coming off. At the end of the article, you can find natural treatment options to address the underlying causes of losing a toenail.

Toenail Falling Off – Symptoms

The medical name for a detached nail that eventually falls off is onycholysis and this can affect toenails and fingernails. Vanessa Ngan from DermNetNZ says that the loosening of the toenail from its nail bed usually starts at the tip of the nail and spreads back.1

Usually, one of the first signs of a toenail falling off is some discoloration of the nail. Vanessa Ngan says that part of the toenail may become yellow, white, or green. If the toenail has been injured, you may have bruising under the nail which looks like a yellowish, black spot.

Depending on the underlying cause why you lose a toenail, you may notice other changes in the toenail and nail bed. For example, researchers from Harvard Health report that fungal infections can cause the toenail to thicken and develop a coarse and uneven edge. If the separation of the toenail from the bed is caused by a side effect of medicines or thyroid problem, then the toenail may just become loose from the bed and fall off.2

Generally, onycholysis is a painless condition and there isn’t usually any pain when the toenail detaches itself and comes off. However, if the nail tears off from parts of the nail bed where it hasn’t separated, the condition can be very painful. Dr. William Blahd on WebMD says that if the reason for the nail coming off is due to injury, you may experience pain and secondary infections.3

Causes of Toenail Falling Off

Let’s look in more detail about the various causes of a toenail falling off and why it can become detached from the toe in the first place.

Repeated trauma or sudden toenail injury

A common reason why toenails fall off is due to repeated trauma. Tight-fitting shoes, a heavy object injuring your toe, or improper pedicure techniques are all to blame for toenails becoming damaged and eventually falling off.

The Journal of the European Academy of Dermatology and Venereology reported that even something as simple as constant pressure from footwear can cause toenail separation from the bed which leads to the toenail falling off.  Also, injury to the nail caused by manicure and pedicure procedures can cause infection and nail bed injury. 3

The Cleveland Clinic reports that frequent injuries to the toes can cause the toenail to fall off from running. This is a condition called “runner’s toe” or “jogger’s toe” and it is often experienced by athletes and marathon runners. Podiatrist, Dr. Georgeanne Botek says that blood blisters can cause the toenail to go black that eventually lift up the toenail which will eventually fall off.4

If your toenail has been injured and you notice bleeding under the nail, you should promptly care for your toenail to prevent it falling off. Dr. William Blahd on WebMD says that simple techniques like putting crushed ice on the injured toe and keeping the foot elevated can help prevent black toenails that drop off.5

You can also prevent losing a toenail due to injury by wearing appropriate footwear. For example, in heavy industries and building work, you should wear shoes that protect your toes from injury. Also, if you enjoy running to keep yourself in good health, wear running shoes that have some extra space for your toes but don’t allow your feet to slide inside your shoe.

Toenail fungal infection

Another common reason why one or more toenails can become detached and fall off is a fungal infection. Yeasts and fungi called dermatophytes can get under the nail and eat away at the tissue in the nail bed. This dislodges the nail and it may start to crumble or fall off.

The Indian Journal of Pharmaceutical Sciences reported on the fungal causes of onychomycosis and the effect on the toenail. Fungal infections can cause thickening of the toenail which becomes loose and can be easily removed. Other signs that your toenail is infected with a fungal infection are discoloration, a flaky appearance, and damage to the nail bed.6

Professor Amanda Oakley from DermNet says that Candida albicans can also affect toenails and can cause the nail to lift up and crumble. Usually, the toenail on your big toe or pinky toe is affected. Candida toenail infections will also discolor your nail and cause the toenail to become yellowish. You may also notice redness and swelling around the cuticle.7

To treat nail infections caused by fungi or yeasts, you should use a topical antifungal treatment. At the end of the article, you can find a natural home remedy using tea tree oil for treating fungal nail infection.

Bacterial infection

Sometimes, bacterial infections can get under the nails causing them to separate from the nail bed and fall off. Some strains of bacteria can cause nail infections that turn them green.

The journal Clinical Interventions in Aging says that constant exposure to water, harsh soaps and detergents, and constant trauma to the nail can aggravate nail infections. Studies have shown that elderly people are more at risk of toenail loss and fingernail loss.8

Viral infection

Damage to the nail bed causing the toenail to become loose and fall off can also be the result of a viral infection.

Some studies into the causes of toenails repeatedly falling off have found a connection with the human papillomavirus (HPV) infection. The American Journal of Dermatopathology reported that small repeated traumas to the toenail can cause a viral infection in the nail bed. This can lead to repeated episodes of the nail growing in and then dropping off.9

Psoriasis of the toenail

Psoriasis can affect the toenails and fingernails causing them to become separated from the nail bed and come off. Psoriasis is an autoimmune condition that causes the overproduction of new skin cells. Apart from psoriasis affecting the nails, the condition causes the skin on the palms to flake and generally affects the scalp, soles of feet, and genitals.

According to the Brazilian Society of Dermatology, around 80% of psoriasis suffers will also develop nail psoriasis. Damage to the nail is caused when the nail plate becomes thicker. This can cause the toenails to become pitted, turn white in color, crumbly, and eventually drop off.10

If you suffer from psoriasis and need to get relief from the discomfort the skin condition causes, please read my article on the best natural remedies for treating psoriasis.

Toenail dermatitis (eczema)

Dermatitis (eczema) is another skin condition that can make you lose one or more of your toenails. Dermatitis can be caused by irritants or allergic reactions to allergens. In some people, dermatitis affects the nail bed and results in the typical symptoms of onycholysis like loss of toenails, fingernails, and crumbly nails.

The journal German Medical Science reported that some causes of nail damage are exposure to harsh chemicals and soaps, prolonged immersion in water, and repetitive trauma. Researchers found that very often, damage to the nail caused by eczema happened before signs of eczema on the skin occurred.11

You can help soothe the discomfort eczema causes by using essential oils such as tea tree oil, lavender oil, and chamomile essential oil. You should remember to dilute 2-3 drops of essential oil in a carrier oil like sweet almond oil or coconut oil before applying to the affected skin.

You can also try out one of my great natural remedies for dermatitis relief.

Too much moisture on toenails

Constantly exposing your feet to too much moisture can cause your toenails to weaken, become loose, and eventually fall off. According to DermNet, this could happen if your feet are immersed in water for a long time.1

However, according to Doctor of Podiatric Medicine, Dr. Myron Bodman, a combination of repeated micro traumas in a moist environment (for example, in shoes) can cause infections to get into the nail bed and result in loss of the nail.12

Uncommon Causes of Toenail Loss

Apart from the common reasons why toenails fall off like trauma and fungal infections, there are some other uncommon reasons that can cause you to lose a toenail.

Some medications can cause loosening of the toenail making it fall off. Dr. TIlmann Oppel reported in the journal German Medical Science that medications for rheumatoid arthritis, some antibiotics, and some antivirals can cause nail shedding.11

DermNet reports that anemia can cause changes in the nail that make them brittle, crumbly, and can cause toenail loss.1 Some other signs of anemia are pale skin, shortness of breath, and cold hands and feet.

A thyroid disorder can be a reason why a toenail breaks off easily and doesn’t grow back properly. Researchers from Harvard Health report that one of the symptoms of an overactive thyroid gland is nails that easily fall off.2 Dermatologists say that once the issue of hyperthyroidism has been addressed, your nails should regrow properly and not fall out again.

Yellow nail syndrome is a rare condition that can cause one or more nails to fall out. According to DermNet, the toenails may appear thick, yellowish, and appear to stop growing. Some topical vitamin E solutions have helped restore nail health.13

Natural Treatment options for Toenail Falling Off

If the toenail has been damaged and shows signs of an injury like discoloration and bruising, there is usually little you can do to repair the damaged nail. However, you can use crushed ice immediately after a toenail injury to minimize the chances of nail separation. You can find below detailed instructions on how to care for your toenail after injury.

Doctors from the American Osteopathic College of Dermatology say that you should cut off any unattached nail. This will prevent the rest of the nail tearing off and causing more injury to the nail bed. Also, you should keep the affected toenail as dry as possible to help speed up the healing process.14

Dermatologists say that other treatments for toenails falling off involve treating the underlying cause of the problem. For example, if you lose toenails because of a fungal infection, you should treat the infection to restore good nail health. You can do this using tea tree oil.

Antifungal tea tree oil

Being a natural antifungal agent, tea tree oil has a number of benefits for skin and nail health. Tea tree oil can help cure dandruff and get rid of acne naturally. A topical application of tea tree oil can also help to rid your nail of fungal infections to stop them crumbling and becoming loose.

The Journal of Family Practice reported that tea tree oil is just as effective as some antifungal nail treatments. One study found that treating fungal-infected toenails with tea tree oil was just as effective as the pharmaceutical drug clotrimazole (used to treat yeast infections). After 6 months of therapy, both groups had the same success in getting rid of toenail fungus and onychomycosis.15

How to use:

Tea tree oil can be used to get rid of fungus from the toenail without diluting. This is what you should do to get rid of onychomycosis:

  1. Gently file and trim any crumbly and loose bits of the nail.
  2. Put a few drops of tea tree oil on the end of a cotton swab.
  3. Paint the tea tree oil on the affected toenail to cure onychomycosis and prevent the toenail from falling off.
  4. Repeat 2 times a day.
  5. Repeat for several months until all signs of fungal infection are completely gone.

You should remember that diligence is necessary because it may take several months to completely get rid of the fungal infection. This is because the infected nail has to grow out before the fungus disappears completely and a new, fungus-free, nail grows back in.

How to treat injured toenail

If your toe has been injured, quick treatment can help to reduce bleeding under the nail and prevent it turning black. Prompt home care for your toenail can also help prevent infections to your toe that can make it fall off.

Doctors from the WebMD recommend using ice to prevent bruised toenail. This is what you should do as soon as possible after injuring your toenail.17

  • Put crushed ice in a sealable plastic bag and wrap in a thin towel.
  • Keep your foot elevated to prevent blood flowing to the injury.
  • Hold the ice pack on for 10-15 minutes on the injured toenail, then rest for 5 minutes.
  • Repeat for 2-3 times each session to reduce the chance of developing damaged toenail which can cause it to fall off.

Remember to see your doctor if the swelling and buildup of blood under your nail is painful or if you have any other concern.

How to Prevent Losing a Toenail

There are a number of ways to prevent losing a toenail by caring for your feet and nails. Dr. Melanie Hecker on Medscape recommends some practical ways to prevent and avoid losing toenails:16

  • Trim your toenails to a comfortable length to prevent repeated trauma from everyday walking.
  • Wear proper fitting shoes to avoid repeated trauma to the toenail and especially your big toe.
  • Keep toenail beds dry and free from moisture to prevent toenail fungus. You can use a hairdryer on a low heat to dry toenails after showering.
  • Avoid using harsh soaps to wash your feet.
  • Don’t allow your feet or toenails to come into contact with irritants.

Read these related articles:

Article Sources

  1. DermNetNZ. Onycholysis.
  2. HealthHarvard. Onycholysis.
  3. J Eur Acad Dermatol Venereol. 2015 May;29(5):848-53.
  4. ClevelandClinic. Tips to protect your toenails.
  5. WebMD. Nail problems and injuries.
  6. Indian J Pharm Sci. 2008 Nov-Dec; 70(6): 710–714.
  7. DermNetNZ. Fungal nail infections.
  8. Clin Interv Aging. 2015; 10: 265–267.
  9. Am J Dermatopathol. 2015 Apr;37(4):329-33.
  10. An Bras Dermatol. 2014 Mar-Apr; 89(2): 312–317.
  11. Ger Med Sci. 2003; 1: Doc02.
  12. StatPearls. Onychomycosis.
  13. DermNetNZ. Yellow nail syndrome.
  14. AOCD. Onycholysis.
  15. J Fam Pract. 1994 Jun;38(6):601-5.
  16. Medscape. Onycholysis treatment & management.
  17. WebMD. Nail problems and injuries.
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