What Causes Thick Toenails and How to Treat Them (2024)

Toenails are naturally thick to protect the tops of your toes. Sometimes, however, they become abnormally thick and can be a cosmetic issue for some people, especially if they become discolored. The change in thickness may be reduced when the underlying cause is treated.

It is natural for toenails to get thicker with age, but other factors, including fungal infections, autoimmune conditions, or mechanical stresses, such as from poorly fitting shoes can also cause thick toenails.

This article discusses the appearance of thick toenails, common causes, and some treatment options.

Signs of Thick Toenails

For most adults, toenails are 1 to 2 millimeters thick. Men generally have slightly thicker toenails than women.

Toenail thickness can be measured using a tool called calipers, but this is mainly done for research.

Most of the time, your healthcare provider will do a clinical assessment and look at your feet to see if your toenails are thicker than expected.

As toenails get thicker, you may notice changes in their appearance and texture, as well as in the feeling (sensation) in your toes and toenails.

Appearance

Toenails become thick when extra layers grow beneath the surface of the nail. If the thickening is too great, the nail may lift off from the nail bed(onycholysis). This usually changes the color of the nail, giving it a white or slight yellow hue.

If the thickening of your toenails is caused by a fungus, they may take on a yellow or brown color. Often, toenail fungus will also cause the nails to become brittle and break off or flake easily.

Smell

An ingrown toenail may have a bad smell, especially if there’s yeast, bacteria, or any drainage (like blood or pus) from an infection.

Sometimes, people notice their toenails give off a “cheesy” odor. This is usually caused by a specific bacteria.

It’s not uncommon to notice a smell when you’re cutting your toenails. But if a toenail is ingrown and there’s a lot of bacteria buildup, you may notice the smell at other times, too.

Texture

Healthy toenails are typically smooth and strong. However, as nails thicken, they can crumble.

Brittle toenails may break, crack, or split easily. The formerly smooth nail may be bumpy and irregular.

Sensation

Thickened toenails may cause discomfort or pain when wearing closed-toe shoes. Thicker toenails may not fit comfortably inside your shoe, causing rubbing, friction, or additional pain while walking.

Paresthesia (numbness or tingling) of the toenail may also occur.

What Causes Thick Toenails?

Thick toenails come from a buildup of the cells that make up your toenails. Possible causes include increased age, nail fungus, peripheral vascular disease, and nail psoriasis (anautoimmune disease).

Aging

As you age, it is natural for your toenail thickness to change. Challenges with foot hygiene can also affect toenail health.

Researchers have found that hip and shoulder flexibility begins to decrease in women over 63 and men over 71. This loss of mobility and changes in hand strength can make it harder to clean feet and clip toenails.

Nail Fungus

Nail fungus is the most common nail disease in the world. It occurs in 10% of the U.S. population and is more common in people living with diabetes, cancer, peripheral artery disease, and human immunodeficiency virus (HIV).

Toenail fungus can spread from another foot fungus (e.g., athlete's foot), or it can spread from a surface like a shower floor or a shoe. Risk factors for toenail fungus include:

• Weakened immune system (e.g., from a chronic illness, cancer treatment)
• Footwear that crowds the toes
• Exercise
• Shared wet spaces like showers and pools

There are somespecific testsand several different treatment options available for nail fungus, though none are 100% effective. Two types of antifungal oral medications are considered the most useful options. These are usually taken while being monitored with blood work to ensure safety.

Nail Psoriasis

Psoriasisis a chronic autoimmune disease that can cause irritated and inflamed patches of skin. In some people, psoriasis also spreads to the nails, causing them to become thick and brittle.

Psoriasis can make your nails weak. They may even fall off completely. There are a variety of treatments for psoriasis that affects the nails. Your healthcare team will work with you to determine which might be best in your case.

Toe Injuries

Runners and other athletes can injure their toenails easily due to the repetitive microtrauma of the nails hitting against their shoes.

If the skin around the nail that’s been injured is also hurt and gets infected, it’s called paronychia.

Yellow Nail Syndrome

A very rare condition called yellow nail syndrome can cause unusual nail changes, usually in older adults.

In addition to having thick, yellow-colored nails, people with the condition have swelling in their legs and respiratory problems.

Ram's Horn Nails

Onychogryphosis, also called Ram’s horn nails, is when the nails turn yellow or brown and get very thick, long, and curved. The big toe nail is most often affected.

Anybody can get ram’s horn nails, but they're more likely to happen because of a foot injury, infection, chronic health condition of the skin (like psoriasis), or a condition that affects blood circulation (like peripheral artery disease).

Ram's horn nails tend to get worse over time and can lead to problems like ingrown nails and toenail infections.

When to Worry About Ingrown Toenails

Having thick toenails usually won’t lead to any major health complications as long as they don’t get infected.

That said, you should let your healthcare provider know if you are seeing changes to your toenails, as it could be a sign of a health problem (including cancer). You may need testing done to reach a diagnosis.

While you might be reluctant to show your toenails, don't worry. Medical providers are comfortable looking at and evaluating all kinds of health concerns.

If you have a hard time keeping your toenails clean and trimmed, you may want to see aprovider who specializes in conditions of the feet and lower legs (podiatrist) for ongoing foot care.

How to Get Rid of Thick Toenails

There isn’t much you can do to quickly get rid of thick toenails. Repairing thick or damaged toenails takes a long time because they grow slowly.

It can take up to a year to fix some toenail problems, even with ongoing treatment.

Self-Care at Home

The simplest way to deal with thick toenails at home is to do a foot soak:

• Mix up some baking soda, Epsom salt, or white vinegar in warm water and let your nails soak in it for a while.
• If you think the ingrown nail is infected, make a soak using a few capfuls of hydrogen peroxide mixed with some water.

Research shows that adding essential oils, such as oregano and tea tree oil, may help improve nail fungal infections. However, they should not be applied directly unless they are properly diluted. Also, you should avoid this type of treatment if you have an allergy or sensitivity to any of these oils.

There’s some evidence that using Vicks VapoRub, the over-the-counter product for congestion, may actually help with toenail thickening. Just put a little on your affected toe once a day.

Make sure your shoes fit well and do not put pressure on your toes.

You may also want to avoid putting any nail polish on your toenails while they’re healing.

If you have had an injury to your toe and your nail is temporarily thick, it may get better over time. As a new, healthy nail grows out, you can see if it gets better.

Debridement

You don’t want to try to scrape out the hard, white stuff in your thick toenails on your own. Doing so can sometimes damage the nail bed beneath the nail plate, which can lead to further thickening of the nail or nail loss. However, there are some ways that a provider can clean out your nails.

Debridement is one such treatment. For this procedure, a podiatrist uses tools to remove extra layers of your toenail to help reduce the thickness. They may also trim your toenail.

After debridement, you may still require treatment for the cause of the nail thickening.

Medication

There are some medications that are available OTC as creams or liquids that get painted on the nail.Check with your provider before trying any of these treatments.

Topical OTC nail treatments may not cure nail fungus because the medication may not be able to pass through the nail to the fungus underneath.

If your nail fungus requires systemic medication (medication that works throughout your body), your provider may recommend oral pills.The pills for fungus treatment can have some serious side effects, so follow your provider’s instructions.

Treatment for nail fungus may require months to a year to be effective.

Laser Therapy

Laser therapyhas been used for nail fungal infections and nail psoriasis.

Researchers are learning about different types of lasers that can be helpful in treating toenail fungus.

Be sure to talk with your provider about how many treatments you may need and what kind of results to expect.

How to Prevent Ingrown Toenails

There are a few ways that you can try to avoid getting ingrown toenails, and it all starts with keeping your feet healthy.

Prevent Fungal Infections

Good foot care can help to reduce your risk of getting a fungal infection and prevent it from returning once you have treated it. Some hygiene tips for your feet include:

• Keeping your toes clean and dry
• Keeping your nails short
• Not sharing nail hygiene tools (like nail clippers)
• Wearing shoes when in shared spaces like locker rooms or pools
• Avoiding shoes that are too tight or too loose

Nail fungus often enters under the nail, so short nails help reduce the risk of infection. Consider sanitizing your nail clippers with rubbing alcohol each time you use them.

Washing and disinfecting your socks and treating your shoes are important parts of hygiene, too—especially if you have nail fungus. This helps to prevent the fungus from reinfecting your toes.

Support Healthy Toenail Growth

Toenails are an important part of your body’s natural outside barrier. They grow an average of 1 millimeter per month. Overall, nail growth tends to slow as you get older.

There are a few things you can do to promote healthy toenail growth:

• Keep nails trimmed.
• Wear well-fitting shoes.
• Minimize or prevent injury to your toenails, such as by being careful walking in the dark and when running or performing vigorous exercise.
  

Summary

Thick toenails have a variety of causes, including advanced age, nail fungus, and psoriasis. They are rarely a major health problem but can cause discomfort. Sometimes, they can be a sign of a condition that needs treatment.

Properly fitting shoes and good foot hygiene will go a long way in preventing and fixing thick toenails. Still, you should see your healthcare provider. They can help you understand any changes to your toenails and recommend a complete plan of care.