Toenail Pitting: What is it?

Written by Erica Halpern on January 16, 2023

Last updated March 20, 2024

Fact: Your toenails can give you clues about your overall health. That’s right, the state of your nails, including toenails, can indicate an underlying health condition. Conversely, healthy nails can be a sign of a healthy lifestyle.

The state of our toenails can differ in a lot of ways. Toenails can splinter, thicken, thin, peel, dry out, break, and pit. Toenail pitting is the focus of this article.

Below, you’ll learn about toenail anatomy, the basics of pitting, signs, treatment methods, and preventative measures to keep your nails in good shape.

Toenail anatomy

Before we delve into the details of toenails and pitting, we must understand their anatomy and the part it plays for our feet.

Toenails are the plate-like covers on our toes. Alpha-keratin, a type of protein, comprises toenails. Alpha-keratin is the same protein building block for hair and the outermost layer of our skin (the epidermis). Generally, the toenail is about 0.5 mm thick and slightly curved.

The toenail consists of several distinct components. The toenail includes the nail plate, the cuticle, and the nail folds surrounding the nail’s perimeter. The part referred to as the toenail colloquially is the “nail plate.“

What’s toenail pitting?

Pitting, by definition, is an indentation. Toenail pitting follows the same logic. Pitting of the nail occurs when tiny dents or “pits” form in the nail plate. Toenail pitting is a type of nail abnormality.

Toenail indents can be shallow and only recognizable by touch. Deep toenail pits may be visible due to their concave nature. Within the grooves, some parts of the pitting may be deeper than others, just as there are deeper and shallow parts of a pit.

Nail pitting is generally more common for fingernails, but toenails are also affected.

What causes toenail pitting?

There are several causes for toenail pitting. Toenail pitting reasons range from external trauma to an underlying medical condition. Learn about the various causes of toenail pitting below.

Nail psoriasis

Psoriasis is a chronic inflammatory disease that can cause toenail pitting. Those with nail psoriasis produce too many skin cells, causing nail irregularities. According to Healthline.com, approximately 80% of those with psoriatic arthritis experience nail irregularities or changes.

You may be able to recognize nail psoriasis because of two related symptoms: discolouration and nail bed separation. There are a few groups more likely to develop nail psoriasis. At-risk factors include:

People who are over 40 (though psoriasis may occur at any age)
Males
Genetics
Psoriatic arthritis

According to a study published in the National Library of Medicine, psoriasis can cause toenail pits “remarkably even in size and depth. Their distribution may be haphazard or sometimes arranged in parallel transverse or short longitudinal lines.”

Though psoriasis is not curable, you can mask the effects of toenail pitting. You can buff or apply nail polish to hide the indents and improve the aesthetic.

Nail eczema

Eczema is a condition that causes itchy and red skin. The disease can cause nail thickening or pitting when eczema targets the feet.

Habit-tic deformity

The habit-tic deformity is a nail condition similar to toenail pitting with several differences. When you constantly pick at your nails, external trauma can create pits in your nail. The habit-tic deformity is most common on the fingernails, specifically the thumbs, but it can also happen on your toenails. For instance, if you sit cross-legged or have your feet at arm’s reach, you may develop a habit of picking at your toenails.

The defining features of habit-tic deformity are horizontal ridges across the nail and a slight depression in the middle of the nail plate. The habit-tic deformity is not severe and typically heals if left alone. The condition is known as “washboard nails” because of the horizontal nail ridges.

Reiter’s syndrome/reactive arthritis

Those with reactive arthritis may experience toenail pitting. An infection or bacterial infection elsewhere in the body can cause reactive arthritis, also known as Reiter’s syndrome. People with a specific type of gene are more likely to develop the condition, as it’s believed to be genetic.

How do you fix nail pitting?

Toenail pitting fixes vary. In some cases, like psoriasis, there is no cure. Cosmetic procedures are an option to mask the effects. Removing external trauma can help reverse toenail pitting in cases like a habit-tic deformity.

Additional treatment options include medication applied to the nail itself. Options include steroids, salicylic acid, calcipotriol, cyanoacrylate adhesive (for the habit-tic deformity) and tazarotene.

Is nail pitting serious?

In most cases, nail pitting as a symptom isn’t severe. Nail pitting is more often a cosmetic issue than a medical issue. However, the underlying conditions that cause toenail pitting can vary in severity.

Get your toenails treated at Feet First Clinic

Healthy toenails start with proper hygiene. To receive our nail care services, book an appointment with one of our chiropodists – no referral is required.

When you book your appointment, indicate whether you seek preventative nail care and maintenance or if you have a specific concern or issue you would like treated. This information will help us allot enough time for your appointment.

About Author: Erica Halpern

Erica is the operations manager at Feet First Clinic. Since 2021, she has been writing, researching and editing website and social media content. She also oversees Feet First Clinic’s daily and strategic operations to ensure the best possible experience for our clients. Her goal is to ensure patients are equipped with the knowledge and solutions they need to help with their pain.

Learn more about Erica Halpern

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October 24, 2024

How to Prevent Toenail Fungus: Tips from a Foot Specialist

There are two common fungal infections that can target your feet. For your skin, it’s athlete’s foot (tinea pedis), and for your nails, it’s fungal toenail (onychomycosis). Fun fact: Onychomycosis is the name for nail anatomy changes caused by contagious fungus, while dystrophic is the term for any other abnormalities that affect how your nails look or grow. Today’s blog will focus solely on toenail fungus. You’ll learn what it is and how to treat it, as well as some top fungal toenail prevention tips recommended by our Toronto chiropodists. Toenail Fungus Symptoms Sometimes toenail fungus is mild and barely noticeable. But fungal toenail can present more severely if you’re immunocompromised, such as if you have diabetes, or a senior. Keep an eye out for these common symptoms: Drastic changes in the nail’s appearance: it can look much thicker, have a yellowish, brown colour, and be very brittle and prone to cracks, despite thickening. Unpleasant odour coming from the nail: the smell is often reported to be sour or like cheese. The nail starts lifting off the nail bed: this is because debris starts to accumulate and lifts the nail up so it can’t reattach. Pain, swelling and bleeding in severe cases. Toenail Fungus Prevention: Foot Specialist Advice The most important fact to remember about fungal toenail is that it’s contagious. Since fungal infections spread easily in damp, shared spaces like pools, gyms, and shower rooms, the best defense is keeping your feet clean and protected! Here are some top, Toronto-chiropodist-recommended tips to remember: Follow a strict, yet fun and relaxing, foot hygiene routine. It’s a part of self care, after all! Wear breathable footwear. Opt for shoes made from materials that allow airflow to keep your feet dry. Change socks daily. Fresh socks prevent moisture buildup, which fungi love. Avoid going barefoot in public places. Use flip-flops or shower shoes to protect your feet in shared spaces. Keep your toenails trimmed and clean. Regular maintenance helps prevent infections from taking hold. Get a professional medical pedicure if you don’t have time to focus on nail care. How to Treat Toenail Fungus Once fungus has gotten a hold of your nails, it’s time to think about treatment and eradicating the problem. Unfortunately, you can’t do much to treat toenail fungus yourself at home, and you often need a chiropodist’s help. Luckily, treatments are easy to follow and non-invasive. Here’s what a foot specialist can do: Perform nail debridement to remove infected parts of the nail. Use prescription-strength topical antifungal medicine on the nail (it penetrates the actual fungus) Educate you on products you can use going forward to prevent re-infection, like the best moisture-wicking socks, shoes, foot creams, deodorants and more.

September 19, 2024

Foot Care for Runners: Preventing Injuries and Maximizing Performance

Whether you're an experienced marathoner or an occasional runner, healthy, happy feet are core to your running success. After all, our feet are the unsung heroes that carry us through kilometres of training and races. Without proper care, our feet and body can only take us so far before we develop aches and injuries. Proactively caring for your feet can help prevent injuries and boost your performance. In this blog post, we dive into our top foot care tips for runners to keep your feet in tip-top shape. Choose the right shoes It all starts with the right pair of running shoes. Everyone's feet are different, so there's no one-size-fits-all. Make sure your shoes fit well—there should be about a finger's width of space between your longest toe and the end of the shoe. The best way to find your ideal shoe is to visit a specialty running store (like our Toronto foot clinic!) where they can analyze your gait and recommend a shoe that suits your running style and foot type. Replace your shoes regularly Another one of our top foot care tips for runners is to replace your running shoes when they wear out. Running shoes don't last forever. Generally, they should be replaced every 450-800km. Worn-out shoes lose their shock absorption, grip, and support, which can lead to injuries. Look for signs like flattened soles or uneven tread to know when it's time for a new pair. You may also notice wrinkles among the various areas of cushioning. Incorporate foot-strengthening exercises Strong feet are less prone to injury. Simple exercises like toe curls, heel raises, and foot stretches can help build strength and flexibility. Try using a resistance band to stretch your feet and calves, and don't forget to roll a tennis ball under your foot to relieve tension and keep things limber. You may also find a lacrosse ball effective for a more rigid plantar fascia massage. Pay attention to your running form Sometimes, foot pain can be traced back to improper running form. Ensure you're landing with your feet underneath your hips rather than over-striding, which can put unnecessary stress on your feet. If you're unsure about your form, consider working with a coach or getting a gait analysis to pinpoint any issues. Stretch and foam roll Stretching isn't just for your legs and back; your feet need love, too. Incorporate foot stretches into your routine, focusing on the Achilles tendon, calves, and the bottom of your feet. For example, do a calf stretch by standing on a step and letting your heels drop below the level of the step. Foam rolling can also help, particularly if you're experiencing tightness in your plantar fascia or Achilles tendon. Keep your shoes dry Blisters and fungal infections love a moist environment. Make sure your feet are dry before putting on socks and running shoes. Choose moisture-wicking socks designed to remove moisture from your skin to help keep things dry. This can prevent blisters and reduce the risk of fungal infections. Consider using foot powder or antiperspirant if you're prone to sweaty feet. For additional moisture prevention, buy two of the same pairs of running shoes and cycle them in and out. Longer durations between uses allow the cushioning to decompress and give your shoes more time to dry thoroughly. Listen to your body Our final foot care tip for runners is to always listen to your body. If you're experiencing persistent foot pain, don't push through it. Ignoring pain can lead to more serious injuries later. Rest, assess, and seek professional advice if needed. Remember, rest days are just as important as training days. They give your feet and body the time they need to recover and adapt to the stress of running.

September 5, 2024

How to Treat and Prevent Athlete’s Foot: Tips from Chiropodists

Athlete's foot is a fungus that infects the skin on your feet. Many people get it, and it can cause a lot of problems. Your feet may itch, turn red, and peel when you have it. This fungus grows best in places that are warm and damp. The good news is that you can treat and stop athlete's foot if you know what to do. Here are some tips from chiropodists (foot specialists) to help you keep your feet healthy and free from fungus. Treatment strategies See a Chiropodist Because of all the moisture buildup on our feet, fungal infections can grow out of control very quickly; they're stubborn and persistent, and once the infection gets under the toenail, it becomes very difficult to treat. In addition, over-the-counter anti-fungal medications are not very effective unless the infection is in the very early stages. That's why it's important to see a chiropodist as soon as you notice any symptoms. A chiropodist will debride and clean up any fungal growth on the skin and prescribe a topical anti-fungal medication to help nip the athlete's foot in the bud before it spreads to the toenails. Oral anti-fungal medications, while effective, are often not recommended due to their side effects. Often, topical prescription anti-fungal medication and persistence are the best way to go. Maintain a rigid hygiene routine Your feet and body will thank you if you keep the infected area clean and dry. Wash your feet daily with soap and water and dry them well between your toes. Fungus grows best in damp places, so ensure your feet are dry before putting on socks and shoes. If you're particularly prone to sweaty feet, you can also try an anti-bacterial foot deodorant like Gehwol's Foot Deodorant spray. This can help prevent Athlete's foot, and even treat it in its very early stages. Avoid scratching Scratching the infected spot can cause other bacterial infections. To soothe the itch, try using antifungal creams or powders. If the infection gets worse or spreads, talk to a doctor. Change socks regularly Choose cotton or merino wool socks that let your feet breathe and wick away sweat. Wear fresh socks every day and change them after physical activity or when they get wet. This helps reduce moisture build-up, which can worsen the fungal infection. Prevention Tips Avoid walking barefoot in public Athlete's foot, along with other fungal infections, are contagious and spread when skin comes into contact with an infected surface. Therefore, always make sure you are wearing some kind of protective footwear in public spaces - like flip flops or slippers - in locker rooms, communal showers, pool decks and gymnasiums. Stick to a foot care routine Clean your feet and dry them well between your toes. Also make sure you cut and clean your toenails often, as fungi can hide under the toenails. Just make sure you don't cut them too short, or you can get an ingrown toenail. Put on the right shoes Pick shoes that let air flow through them. Avoid (if possible) wearing the same shoes all day, every day, and ensure they're dry before putting them on. Use flip-flops or water-safe sandals in public spots like pools or gym showers to avoid touching infected surfaces. Clean Your Shoes Fungal spores can hang around in shoes, which will feed the infection. To combat this, spray your shoes and socks with antifungal and antibacterial products, such as hypochlorous acid, zinc oxide or zinc incoleate, and dry them out before you put them on again. You can use Gehwol Foot & Shoe Deodorant Spray in your shoes, or dust Gehwol Foot Powder into your socks. These products contain zinc oxide and zinc ricinoleate, respectively, which are great for maintaining a healthy environment in your shoes. You can find these products at our Toronto foot clinic. Keep personal items to yourself Don't let others use your towels, socks, or shoes, and vice versa. Fungal infections are contagious and spread through touching or sharing personal items with people who have a fungal infection.

September 2, 2024

How to Recognize and Treat Ingrown Toenails Safely

Ingrown toenails can be more than just a foot problem. Quite frankly, they're annoying. They can also lead to significant discomfort and even serious complications if not addressed properly. Many people don’t even fully understand what they are or what “ingrown” really looks like, so recognizing ingrown toenails early is crucial! This will allow for prompt, effective and safe ingrown toenail treatment, which will reduce your risk of infection and help you avoid more invasive procedures. Recognizing Ingrown Toenails So, how can you tell if you’re dealing with an ingrown toenail? The first symptoms include pain and tenderness along the side edge of your toenail (the exact location is the called the paronychium, or the soft tissue border around the nail), typically on the big toe. Why the big toe? It is larger and more vulnerable! It withstands the most damaging effects from poor foot care habits (more on that later). You might also notice swelling, redness, and warmth in the affected area. If the condition progresses, pus may develop, indicating an ingrown toenail infection. Catching these signs early is key to avoiding further issues. Visually, it may look curved or embedded, or simply like a tiny, strange nail growth attached to the main nail. You may also see skin growing over the nail. Ingrown Toenails Causes Ingrown toenails result from seemingly innocent routines that over time, damage your foot health. These include improper nail trimming — cutting nails too short or rounding the edges (many people do this for aesthetics but it's a big no-no!) which encourages the nail to grow into the skin. Tight shoes that squeeze the toes together (your feet may be wider than you think), as well as injuries to the toenail, are also common culprits. In some cases, genetics may play a role: some people's natural nail shape and growth pattern may make them more predisposed to developing ingrown toenails, like involuted or pincer toenails. Knowing these causes gives you the upper hand in preventing ingrown toenails before they start. Preventing Ingrown Toenails Wherever possible, prevention is always better than cure. By trimming your nails straight across, wearing shoes that fit properly, and keeping your feet clean, you can significantly reduce the risk of developing ingrown toenails and a corresponding infection. If you’re unsure how to cut your toenails properly, especially if you have conditions like diabetic neuropathy, seeking help from a chiropodist for a medical pedicure can be a smart choice. People with diabetes need to be extra vigilant about foot care, as their condition can make them more susceptible to complications from ingrown toenails. Click here to see how a deceptively minor laceration can turn into an ulcer. Regularly checking your feet, especially if you’re prone to ingrown toenails, is also an essential part of care. Treating Ingrown Toenails For mild cases in the early stages, soaking your foot in warm water for 15 minutes 2 times a day can soften the skin and reduce swelling. After, you can wedge a wet piece of cotton under the corner of the toenail to help lift the ingrown portion while it heals. But beware—safe ingrown toenail treatment at home requires careful handling to avoid making things worse. And whatever you do, do not attempt to cut the toenail or dig the ingrown portion out. If there's no improvement in 3 days, or if you're experiencing any pain or irritation, seeking professional ingrown toenails treatment from a Toronto chiropodist is a better idea. For safe ingrown toenail treatment, always see a chiropodist - do not go to a salon. If you try to treat your ingrown toenail at home (or at a salon), you can get an infection and make things worse. Plus, when you do ultimately see the chiropodist, the chiropodist will have to cut the toenail even shorter than they normally would in order to fix the DIY job. This lengthens the healing process. If the pain is severe and you’re waiting for your chiropody appointment, try the following tips for ingrown toenail relief: Soaking your feet in warm (not hot) water with Epson salts: The salt is a natural disinfectant and will help clean the wound so that it doesn't get infected and become further irritated. If there are signs of infection (i.e.: bleeding, discharge), wear a band-aid over the ingrown toenail when you're wearing shoes and socks to prevent bacteria from getting stuck in the wound. Try over-the-counter pain relievers like Tylenol or Ibuprofen These can offer temporary comfort before you can address the root cause and follow proper treatment guidelines. Safe Ingrown Toenail Removal Safe ingrown toenail removal with a licensed chiropodist is always the best way to go. Most ingrown toenails do not need to be surgically removed: a chiropodist can typically safely remove it non-surgically with sterilized tools in a sanitized, safe environment. They can also cut the toenail in a way to prevent it from coming back. In severe cases (like if you attempted to fix your own ingrown toenail and it got infected, or your ingrown toenail keeps coming back), safe ingrown toenail treatment may involve a minor surgical procedure from a chiropodist called a total or partial nail avulsion.

August 15, 2024

Secondary Toenail: What It Is and How to Handle It

Whether they're discoloured, cracked, ingrown, curly, or on the verge of falling off, toenail anatomy can be fragile and our nails can do funny things. A less commonly discussed issue is a secondary toenail. Also known as an accessory toenail or petaloid toenail, a secondary toenail is a sneaky little extra nail twin that grows alongside or beneath the pinky toenail. This abnormal toenail growth can be concerning, so it’s natural to have questions. Signs You Have a Secondary Toenail It’s important to know the difference between an ingrown toenail and an accessory toenail. First, ingrown toenails can grow on any toe, whereas a secondary toenail appears on the fifth, smallest toe. Ingrown toenails are also far more common, and pierce the skin rather than growing alongside the nail. Secondary toenails are thin in nature and often don’t cause pain, infection or swelling like ingrown toenails do (although it is possible). Lastly, ingrown toenails form on the side of the nail unit, whereas secondary toenails grow underneath the proper nail. What Causes a Secondary Toenail? A secondary toenail is a rare phenomenon. It often makes an unexpected appearance after trauma or injury to the nail bed. You may notice your nail growing differently after stubbing or hurting it. Chronic pressure from tight shoes or less-than-perfect nail trimming can also coax this extra nail into existence. Do You Need Surgery For Secondary Toenails? Studies show that the treatment of choice for this extra pinky toenail is an excision, especially if it’s infected. A partial or total nail avulsion from Toronto’s Feet First Clinic may be the solution you need, but you’ll have to schedule a proper foot assessment to determine the best course of action. Treatment of accessory toenails targets the original toenail, not the second one. The second toenail should grow properly after the “main” nail is removed.

August 1, 2024

Tips For When Your Toenail Is on The Verge Of Falling Off

A toenail falling off can be uncomfortable and cause concern about damage to the toenail. The goal is to preserve the toenail's state to prevent further damage. Fortunately, if you take a few proactive steps, you can reduce the discomfort and promote healing. Here are our six tips for managing a toenail on the verge of falling off. 1. Keep the toenail area clean and dry Wash the toenail gently and often. We recommend using mild soap and water to keep it clean. Next, pat dry so as not to snag the toenail with a towel. 2. Cut the nail carefully and slowly Use clean, sterilized nail clippers to remove any dangling or loose portions of the toenail. Cut straight across without digging into the surrounding skin. The goal here is to prevent further snagging or tearing down the road. Improperly cutting your nail may also increase your risk of an ingrown toenail. In addition to trimming the toenail straight across, you should trim the toenail slowly. Don't over-cut it. Be patient with toenail growth. (It may take months to a year for a nail to fully grow out.) If in doubt, let our toenail specialists in Toronto trim your toenails for you as part of a medical pedicure. 3. Use a non-stick bandage to protect the area We recommend applying a bandage or non-sticky wrap to your toe. (Adhesive can attach itself to the toenail and be difficult to peel off without grabbing onto it.) A protective layer keeps an otherwise exposed nail bed safe. Replace the bandage regularly and keep the area dry to promote healing. 4. Antiseptic ointment is your friend Use an antiseptic ointment or petroleum jelly on the exposed nail bed to keep it moisturized and prevent infection. This may help soothe any discomfort from the loose toenail. 5. Choose comfortable and roomier footwear You'll want to reduce pressure as much as possible to prevent a loose toenail from falling off. Given that we wear footwear so often, finding shoes with ample fit can help prevent further damage to the toenails. 6. Avoid intense activity Reduce your activity level if it puts excessive pressure or strain on the affected toenail. For instance, running or high-impact sports like soccer could increase the risk of the toenail getting snagged or torn off. Give your toe some rest, and return to physical activity gradually.

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