A thick, yellow or painful toenail can be more than a cosmetic annoyance. It may catch on socks, make shoes uncomfortable or become difficult to cut safely. It’s easy to assume that a discoloured or damaged nail is fungal, but several conditions can affect toenails and change their appearance.

At Feet By Pody, we assess a wide range of toenail problems and recommend treatment based on the underlying cause. Three of the issues we see most often are fungal nail infections, ingrown toenails and toenail trauma.

Although each can affect how your nails look and feel, they require different approaches. Here, we explain how to recognise the likely problem, what may help, and when it’s time to seek professional advice.

1. Fungal Infections (Onychomycosis)

A fungal nail infection can affect one or several toenails. Typical signs include:

• Thickened nails that become white, yellow or brown
• A brittle, crumbly or uneven nail surface
• Nails that are difficult to cut or increasingly uncomfortable in shoes.

The infection often starts at the edge of the nail and gradually spreads. You may be more at risk if you’re prone to athlete’s foot, tend to have sweaty feet or wear closed shoes for long periods. Fungal nail infections also become more common with age.

However, not every thickened or discoloured nail is fungal. Tight shoes, long-distance running, hiking, an old injury and some skin conditions can also leave nails ridged, thick or distorted.

This is why a diagnosis matters. A podiatrist can take a nail clipping for testing before you spend months using the wrong treatment. Confirmed fungal nails may be managed with professional nail reduction, topical antifungal treatment and/or oral medications prescribed through your GP.

Toenails grow slowly, so improvement takes time – even after the treatment has worked.

2. Ingrown Toenails

An ingrown toenail develops when the side or corner of the nail presses into the surrounding skin. It can be painful, especially in shoes or when putting pressure on the affected toe. Typical signs include:

• Pain or tenderness along one or both sides of the nail
• Red or swollen skin around the nail edge
• Discomfort when walking or wearing close-fitting shoes
• Discharge or increasing pain if the area becomes infected.

Ingrown toenails can be linked to cutting nails too short or down the sides. Curved nails, tight footwear, toe injuries and repeated pressure can also contribute.

Mild cases may improve with gentle home care. Avoid digging into the nail corner, as this can worsen the problem. A warm-water soak may ease discomfort, but seek professional advice promptly if you have diabetes, poor circulation, nerve damage or signs of infection.

If the nail repeatedly breaks the skin, becomes infected or remains painful, partial or total toenail surgery may offer longer-term relief. A local anaesthetic numbs the toe during the procedure; dressings and follow-up appointments support healing.

3. Toenail Trauma

A toenail can bruise, split or lift after stubbing your toe, dropping something on it or repeatedly knocking it against the front of a shoe. This is common among runners, hikers, dancers and people who spend long periods on their feet. Typical signs include:

• A red, purple or dark patch beneath the nail
• A split, cracked or partly lifted nail
• Tenderness or throbbing after an injury
• A nail that catches on socks or feels uncomfortable in shoes.

Minor damage may only need careful management while the nail grows out. Keep it clean and dry, avoid pulling off a loose nail, and wear shoes with enough room around the toes. Carefully trim or file loose edges, but don’t cut deeply into the nail or surrounding skin.

Seek professional advice if pain is severe, the nail is substantially detached, or redness, heat, swelling or pus develops. A podiatrist can reduce a thick, sharp or partly detached nail if it’s painful or difficult to manage. If blood collects beneath the nail and causes pressure, a small hole may be needed to release it. In serious cases, part or all of the nail may need to be removed.

When Nail Changes Need Prompt Assessment

Arrange a prompt assessment if you notice:

• A new, unexplained dark brown or black mark on a nail
• Increasing pain, warmth, swelling or discharge
• A nail that changes colour or shape without an obvious cause
• A persistent nail problem if you have diabetes, poor circulation or a weakened immune system.

Getting the right diagnosis helps ensure appropriate treatment. If a toenail is painful, persistently changing or becoming difficult to manage, book an appointment with Feet By Pody at one of our London Foot Clinics for expert assessment and treatment.

Whether you have a specific toenail problem or simply need trustworthy advice, our experienced podiatrists are here to help.

Clinically reviewed by Nicolas Ivanoff, Podiatrist & Clinical Director
Nicolas qualified in podiatry in 2005 and has worked in private practice ever since. He founded Feet By Pody in 2006 and has particular clinical interests in nail surgery, verrucae needling, shockwave therapy and biomechanics.