Thick Toenails: Causes and Treatment
Most nail techs have seen them—thick toenails that resist easy clipping and may show signs of yellowing, the presence of fungus or other nail-related concerns.
By remaining aware of the problem and its possible causes, you have the ability to help these clients both at your station and between appointments with homecare suggestions. We spoke to medical experts to find out more about what causes thickened toenails and how you should proceed when faced with this situation in your salon.
Thick toenails may be caused by several issues, from outer trauma to more serious internal conditions, but they are universally common in the aging population. “When people age, the nail can become thick coming out of the matrix, such as with onychogryphosis [nails that are thick and curving],” explains Joseph Jorizzo, MD, former and founding chair of the Dermatology Department at Wake Forest in Winston-Salem, North Carolina. “However, the most common cause of thick toenails is a fungal infection [onychomycosis], which causes a chewing of the nail from its end in a tunneling way, known as distal tunneling dystrophy [onychogryphosis].” He notes that 50% of men over the age of 50 and a lower percentage of women have experienced onychogryphosis (tunneling dystrophy), while onychomycosis (fungal infection) occurs equally among the sexes and is common in senior citizen clients. Techs, meanwhile, may observe onychomycosis due to superficial white speckling of the nail and, over time, a crumbly, thicker nail.
If age or fungal infection doesn’t seem to be the cause of your client’s thickened nails, other factors may be at work. Amy Newburger, MD, director of Dermatology Consultants of Westchester in Scarsdale, New York, notes several additional reasons for thick toenails: lymphodema (which leads to thickened, smooth, opaque yellow nails caused by poor return of lymph fluid); poor circulation (and may be accompanied by varicose veins); ill fitting shoes or trauma (often seen in athletes, the toenails thicken like a callus would grow on skin); or in clients who have psoriasis. “Ultimately, however, the most common causes boil down to age, circulation issues or infection,” Newburger explains.
Some of these problems can be handled with preventative measures, such as the selection of proper footwear—and perhaps the frequent services of a nail professional. “Regular foot care may be preventative; with the increase in diabetes, foot care is mandatory to avoid surgery and limb loss,” notes Larry Millikan, MD, professor emeritus at Tulane Dermatology in New Orleans. “Circulatory problems, especially in diabetics, can lead to amputation.” Though diabetic foot care is a complex topic, it’s important to learn the proper procedures for these clients and ask about their medical history on client intake forms so you can be aware of these more serious concerns.
Meanwhile, for other circulatory problems, Newburger says that preventative action is possible. “If clients want to help keep their nails looking normal, support hose or socks can help in cases of sluggish circulation,” she suggests. “When feet are swollen at the end of the day, that’s a telltale sign, and people with this symptom are also more likely to have thick toenails.” If your client complains of swollen feet, or you notice this during a pedicure service, suggest this course of action to save her from additional issues, such as thickened toenails or varicose veins, down the road.
What to Do
Nail techs faced with clients who already have thickened toenails may wonder what they can do to help them. Luckily, you can take several steps to provide relief. As with any client, commit to proper sterilization before and after each service. If thickened nails are accompanied by fungus, bacterial infections or crumbliness, these steps are crucial. “Make sure there are no breaks in the skin or nail, which is more likely to produce infection,” emphasizes Jorizzo. “Also be careful working around the cuticles or underneath the ree edge; if the seal is broken, there’s an open space for bacteria or yeast to grow.” If a nail is crumbly and has flaky residue underneath the free edge, avoid scraping that out; this may be present in clients with psoriasis. Ultimately, for any nail issue that shows “gross distortion,” says Jorizzo, refer the client to a podiatrist or medical professional. For nails that are still intact, it’s acceptable to gently file down the nail as long as you don’t file it too thin (this can increase the possibility of infection).
Newburger offers additional tips for thick toenails: For age-related thick or curling nails, recommend the client dissolve some of the excess keratin a few days before the appointment using an over-the-counter keratolytic, such as Carmol 20 (a 20% urea lotion), salicylic acid gels (up to 6% concentration) or AHA products; this will enable you to trim the nails more easily. “If nails are polished, this step won’t be effective, but layered on bare nails daily leading up to an appointment, keratolytic or salicylic acid products will make the nails softer,” Newburger explains. “In the salon, a tech prepping nails with such products can also make them easier to trim. She can soak the client’s feet with a salicylic acid-containing product dissolved in a foot bath.”
In cases where fungi has caused thickened nails, incorporate a topical antifungal product in your regimen and apply it prior to the base coat. Use clippers to trim the nails, then file them gently, as thickened nails are susceptible to splintering. Don’t put any undue pressure on the nail that may cause separation from the nail bed. Finally, clients with thickened toenails may also be prone to ingrown nails, so smooth the edges without going deep into the nail fold.
Thickened toenails have a multitude of causes, but you can make sure you’re doing the best work for your client by inquiring about the underlying cause and proceeding with caution. To avoid making her problem worse, take note of any additional issues that may be present, such as yellowing, lifting, crumbliness or fungal infections. By using your powers of observation and opening a dialogue with your client, you’ll make sure you customize services for her needs—and isn’t that what being a nail tech is all about?