Toenail Issues From Hammer Toe

Hammer toe is a progressive condition. In the beginning, it may not be painful or impact your life too much.

But as it progresses, it can cause pain, swelling, and stiffness in the toe, as well as other conditions that can affect the foot and the toenails.

Toenail issues from hammer toe can be common, especially if you aren’t wearing the right shoes. The key is to take precautions from the start or to treat toenail problems early if you see them starting to develop.

Let’s have a look at how to treat toenails issues from hammer toe so you can be as pain-free as possible.

How Do You Treat Toenail Issues from Hammer Toe?

1. Ingrown and Incurvated Toenail

When your toenail becomes ingrown, it begins to grow inwards and the sharp corners dig into the skin of the toe.

This can be painful as it cuts into the skin, and it can cause inflammation, redness, and in some cases, infection.

Often you’ll find that the skin around the toenail becomes red and swollen. The whole toe may eventually swell and become red, which is a sign of infection in the area.

Ingrown toenails on hammer toes can be caused by the unusual shape of the hammer toe causing the tip of the toe to push against the shoe’s upper or midsole. This pressure can push the nail out of its position and cause it to grow into the skin instead of straight.

Wearing the right shoes for hammer toes can stop this from happening and reduce the chance of developing an ingrown toenail. Make sure the toe box is wide and deep enough to allow your toes to splay and not have any pressure points or hotspots.

Treatment

If you begin to feel your toenail pressing into your skin, the first thing you should do is cut it back with nail clippers.

In some cases, the toenail can grow into the skin without you feeling it at first until it’s embedded in the skin and cannot be removed with a nail clipper.

In this case, you may need to visit a medical professional to have the ingrown toenail removed.

Depending on the severity of the ingrown toenail, the doctor may choose to remove a small part of the nail or to remove the entire nail and nail root. This is usually done under a local anesthetic.

2. Thick Nail

A thickened toenail—known as onychogryphosis or ram’s horn nails—can also develop as a result of hammer toes. The nail becomes abnormally thick and may grow strangely or become excessively curved.

Some of the most common reasons for this are an existing nail disease or fungus. But in the case of hammer toes, the thickening of the nail is caused by nail injury.

If you wear shoes with a tight and small toe box, the position of the hammer toe could cause the nail to be subjected to excessive pressure. This kind of stress on the nail can lead to a thickening of the nail.

It often begins with hypertrophy—an increase in size—of the area of the nail bed. This may go unnoticed, especially as it isn’t always accompanied by pain. This leads to a fungal or yeast infection developing in the nail bed, which results in the abnormal thickening of the nail.

It may be accompanied by a strong, unpleasant odor and mild to severe itching. The nail may also begin to grow uncontrollably and be too thick to cut with any conventional toenail tools.

Treatment

A thickened, fast-growing toenail needs to be surgically removed. The doctor will remove the toenail and clean the nail bed, ensuring that all signs of the infection have been removed.

Often, the doctor will also treat the damaged skin underneath and next to the nail bed. If the damage is severe, a small skin graft may be necessary.

In severe cases, when the nail has been repeatedly cut back but the thickening continues to worsen, the doctor may choose to remove the entire nail including the root so it cannot grow back.

Once the nail has been removed—whether it’s just a piece or the entire nail—the doctor will prescribe a topical cream and possibly medication to make sure a secondary infection doesn’t occur.

3. Fungus

Fungal infections in hammer toes also often occur as a result of incorrect footwear.

Fungi—mold or yeast—live in the environment around us, and especially in closed, warm, moist environments like shoes.

If the toenail becomes damaged, for example, if the hammer toe is positioned in such a way that the toenail rubs against the front of the toe box and becomes inflamed or creates a small open wound, fungi can enter the skin through this weak point.

A nail fungus can manifest in a variety of different ways. These could include a discoloration of the nail—brown or yellow—abnormal thickening of the nail, cracks in the nail, or flaking of the nail.

This condition often isn’t painful until it’s very advanced. To prevent this from happening to your toes, make sure you’re wearing the right footwear and take good care of your feet. Avoid walking barefoot in public places or places that are dirty.

Treatment

Nail fungi need to be treated with antifungal medication. In most cases, this will cause the infection to go away. It may take more than one course of antifungal medication if the toenail infection is severe.

The doctor will usually prescribe oral antifungal medications, as well as a topical antifungal ointment. If the infection is severe, the doctor may decide to remove the nail entirely.

In some cases, the nail fungus can spread to other parts of the foot. A stronger and longer dose of medication will be needed for these cases.

4. Bone Spur Under the Nail

A bone spur underneath the nail bed—known as subungual exostosis—is when lesions made of bone and cartilage form underneath the nail bed.

This can be caused by the skin between the nail and the bone becoming inflamed. Hammer toes may cause this to happen due to their V-shape pressing the toe down into the bottom of the shoe, or overlapping toes placing pressure on each other.

These bone spurs present as calluses or corns underneath the nail. It may look like a black mark on or underneath the nail.

Because of their awkward positioning, they can cause pain as they press against nerves in the toe. They can also become infected easily, which will cause pain, inflammation, redness, and swelling in the area.

Treatment

The only way to treat a bone spur underneath the nail is to have it surgically removed. You can use nonsteroidal anti-inflammatory drugs, such as ibuprofen or Naprosyn to relieve pain, but a bone spur won’t get better on its own.

The doctor will remove the affected nail and smooth down the growth of bone until it’s at a normal level. You will need to keep the toe protected until the nail has grown back.

5. Toenail Injury

If you have a hammer toe, your toe is positioned differently from what it would be normally. This can leave you at greater risk of injury to the toe, which can lead to a variety of toe and toenail conditions developing.

If you’re wearing shoes but they’re not quite right for your feet—have inadequate arch support that causes the foot to move out of alignment, or have a tight toe box—your toenails are at risk of injury due to a lack of space or being misaligned.

If you walk barefoot, the unusual position of the hammer toe could cause the toe to be more easily bumped and bruised, leading to toenail injury.

Common toenail injuries include subungual hematoma—bruising or bleeding underneath the nail—cracked or torn nails, or a splinter becoming embedded underneath the toenail.

These can cause pain, swelling, and redness at the site of the injury.

Treatment

If not treated promptly, toenail injuries can become worse and result in an infection at a later stage. Depending on the severity of the injury, it could get better by applying the RICE principle—rest, ice, compression, and elevation.

Spending some time off your feet, allowing the injured toe to rest and not be subjected to the pressure of shoes, can help. In these cases, hammer toe socks and toe straighteners are useful. Hopefully, the toenail heals, although likely slowly.

But if the injury is severe, causes pain that interferes with your daily life, or becomes infected, then surgery may be required to remove the toenail.

If an injury has occurred beneath the toenail, the toenail may need to be removed in order to take pressure off of the injury and allow it to heal. It’s best to consult your doctor if you’ve experienced a toenail injury and get their advice.

American Academy of Orthopaedic Surgeons. “Ingrown Toenail – OrthoInfo – AAOS.” Www.orthoinfo.org,
www.orthoinfo.aaos.org/en/diseases–conditions/ingrown-toenail
Accessed 8 Oct. 2021

Centers for Disease Control and Prevention. “Fungal Nail Infections.” CDC, 2019,
www.cdc.gov/fungal/nail-infections.html
Accessed 8 Oct. 2021

Gaillard, Frank. “Subungual Exostosis | Radiology Reference Article | Radiopaedia.org.” Radiopaedia, 4 Mar. 2020,
www.radiopaedia.org/articles/subungual-exostosis
Accessed 8 Oct. 2021

Lashkari, Cashmere. “Onychogryphosis – Ram’s Horn Nails.” News-Medical.net, 4 Jan. 2017,
www.news-medical.net/health/Onychogryphosis-Rams-Horn-Nails.aspx
Accessed 8 Oct. 2021. 

Share on facebook
Share on twitter
Share on pinterest
Share on email
Share on print